Does the addition of functional status indicators to case-mix adjustment indices improve prediction of hospitalization, institutionalization, and death in the elderly?
Does the addition of functional status indicators to case-mix adjustment indices improve prediction of hospitalization, institutionalization, and death in the elderly?
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DOI：
10.1097/01.mlr.0000185749.04875.cb
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发表时间：
2005-12-01
期刊：
影响因子：
3
通讯作者：
Tamblyn, R
中科院分区：
文献类型：
--
作者：
Mayo, NE;Nadeau, L;Tamblyn, R
背景资料：病例组合调整被广泛用于卫生服务研究，以确保被比较的群体在预测结果的变量上是等同的。从行政数据库中记录的诊断代码中导出的合并症指数已经有了相当大的发展和测试，但越来越多的临床信息和患者报告的健康和功能状态评级的好处正在得到认可。功能状态指标（FSI）是一种被高度重视但至今尚未被行政健康数据库捕获的信息类型。目的：本研究的目的是评估通过纳入功能状态指标（FSI）信息可以改善健康结果预测的程度。研究设计：本研究的数据来自于1997年至1998年进行的一项评估老年人药物治疗管理的计算机决策支持的随机分组试验。共有107名初级保健医生参加了这项试验，其中6465名患者（51%）在干预前完成了一项通用健康状况测量-SF-12。用C统计量和R2比较社会人口学因素、2个共病指数和11个来自SF-12和编码的FSI预测变量的预测价值使用国际功能分类（ICF）进行评估（可能为8人）。使用逐步逻辑回归，FSI，特别是爬楼梯或做家务等中等活动的限制，被发现是强大的和独立的预测所有的结果，即使在控制了社会人口统计学和comormality.Conclusion：这项研究表明，FSI提供了强大的预测健康事件复杂的comormalityindex。此外，ICF编码系统提供了一种机制，通过使用包括健康或功能状况计量的电子健康记录，可以将有关家庭团聚的信息纳入行政数据库。
Background: Case-mix adjustment is widely used in health services research to ensure that groups being compared are equivalent on variables predicting outcome. There has been considerable development and testing of comorbidity indices derived from diagnostic codes recorded in administrative databases, but increasingly, the benefit of clinical information and patient reported ratings of health and functional status is being recognized. One type of information that is highly valued but has so far not been captured by administrative health databases is functional status indicators (FSI).Objective: The purpose of this study was to estimate the extent to which prediction of health outcomes can be improved on by including information on functional status indicators (FSI).Research Design: The data for the current study was obtained from a clustered randomized trial evaluating computerized decision support for managing drug therapy in the elderly, conducted from 1997 to 1998. A total of 107 primary care physicians participated in this trial and 6465 of their patients (51%) completed a generic health status measure-the SF-12-before the intervention. C statistics and R 2 were used to compare the predictive value of sociodemographic factors, 2 comorbidity indices, and 11 FSI predictor variables derived from the SF-12 and coded (possible for 8) using the International Classification of Functioning (ICF).Results: Using stepwise logistic regression, FSI, particularly limitation in stair climbing or doing moderate activities like housework, were found to be strong and independent predictors of all outcomes, even after controlling for sociodemographics and comorbidity.Conclusion: This study indicates that FSI provided as robust a prediction of health events as did complex comorbidity indices. Additionally, the ICF coding system provides a mechanism whereby information on FSI could be incorporated into administrative data-bases through the use of electronic health records that include a health or functional status measure.