Refined comorbidity index based on dimensionality of comorbidity for use in studies of health-related quality of life
Refined comorbidity index based on dimensionality of comorbidity for use in studies of health-related quality of life
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DOI：
10.1007/s11136-016-1306-6
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发表时间：
2016-10-01
影响因子：
3.5
通讯作者：
Balkrishnan, Rajesh
中科院分区：
文献类型：
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作者：
Ou, Huang-Tz;Lin, Chung-Ying;Balkrishnan, Rajesh
为了将健康相关生活质量共病指数（HRQoL-CI）的两个分量表细化为一个单一的指数测量值，分别使用2010年和2012年医疗支出面板调查作为开发和验证数据集。应用最小绝对收缩和选择算子来选择与HRQoL相关的重要合并症候选者。探索性因素分析和验证性因素分析（CFA）被用来评估维度的共病。基于CFA的标准化因子负荷和HRQoL预测模型的回归系数推导出统计权重。比较HRQoL-CI和Charlson CI（CCI）的预测误差和模型R-2值。CFA模型表明，二阶多维协方差结构比一阶一维结构对数据有更好的拟合。在多维结构下，使用统计权重的改进尺度的预测性能在预测模型的平均预测误差和R-2方面优于原始尺度和CCI（对于一般健康状况、SF-6D和EQ-5D，精细尺度模型的R-2值分别为0.25、0.30和0.28，而CCI的R-2值分别为0.10、0.09和0.06，协方差的维数和权重方案显著提高了改进的HRQoL-CI的性能。在HRQoL研究中，改良的单一HRQoL-CI指标似乎是一种适当且有效的风险调整工具。未来的研究，验证不同文化，年龄组和医疗保健设置的细化尺度是必要的。
To refine two subscales of the health-related quality of life comorbidity index (HRQoL-CI) into a single index measure.The 2010 and 2012 Medical Expenditure Panel Surveys were utilized as development and validation datasets, respectively. The least absolute shrinkage and selection operator was applied to select important comorbidity candidates associated with HRQoL. Exploratory factor analysis and confirmatory factor analysis (CFA) were used to assess dimensionality in comorbidity. Statistical weights were derived based on standardized factor loadings from CFA and regression coefficients from the model predicting HRQoL. Prediction errors and model R-2 values were compared between HRQoL-CI and Charlson CI (CCI).Eighteen comorbid conditions were identified. CFA models indicated that the second-order multidimensional comorbidity structure had a better fit to the data than did the first-order unidimensional structure. The predictive performance of the refined scale under a multidimensional structure utilizing statistical weights outperformed the original scale and CCI in terms of average prediction error and R-2 in the prediction models (R-2 values from refined scale model are 0.25, 0.30, and 0.28 versus those from CCI of 0.10, 0.09, and 0.06 for general health, SF-6D, and EQ-5D, respectively).The dimensionality of comorbidity and the weight scheme significantly improved the performance of the refined HRQoL-CI. The refined single HRQoL-CI measure appears to be an appropriate and valid instrument specific for risk adjustment in studies of HRQoL. Future research that validates the refined scales for different cultures, age groups, and healthcare settings is warranted.