Comparison of count-based multimorbidity measures in predicting emergency admission and functional decline in older community-dwelling adults: a prospective cohort study
Comparison of count-based multimorbidity measures in predicting emergency admission and functional decline in older community-dwelling adults: a prospective cohort study
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DOI：
10.1136/bmjopen-2016-013089
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发表时间：
2016-01-01
期刊：
影响因子：
2.9
通讯作者：
Smith, Susan M.
中科院分区：
文献类型：
--
作者：
Wallace, Emma;McDowell, Ronald;Smith, Susan M.
目的：多发病定义为个体存在2种或2种以上慢性疾病，与较差的健康结果相关。目前存在几种多指标衡量方法，面临的挑战是决定在预测健康结果时优先使用哪一种。本研究的目的是比较5种基于计数的多指标在预测参加初级保健的老年社区居民急诊入院和功能下降方面的表现。设置：爱尔兰的15个全科医生（GP）。参与者：n=862，≥ 70岁，社区居民随访2年基线接触：五项多剂量测量（疾病计数、选定条件计数、Charlson合并症指数、RxRisk-V、药物计数），使用全科医生病历和关联的国家药房索赔数据计算。（1）急诊入院和门诊护理敏感（ACS）入院（全科医生病历）和（2）功能下降统计分析：描述性统计和测量歧视结果：中位年龄为77岁，53%为女性。流行率范围为37%至91%，这取决于使用何种措施来定义多发病。所有指标均显示对紧急入院（c统计范围：0.62，0.65）、ACS入院（c统计范围：0.63，0.68）和功能衰退（c统计范围：0.55，0.61）结果的区分度较差。基于药物的措施相当于诊断为基础的measures.Conclusions：措施的选择可能会有显着的影响流行率。五个多变量测量在预测急诊入院和功能下降方面表现出较差的辨别力，基于药物的测量相当于基于诊断的测量。孤立地考虑多发病不足以预测社区环境中的这些结果。
Objectives: Multimorbidity, defined as the presence of 2 or more chronic medical conditions in an individual, is associated with poorer health outcomes. Several multimorbidity measures exist, and the challenge is to decide which to use preferentially in predicting health outcomes. The study objective was to compare the performance of 5 count-based multimorbidity measures in predicting emergency hospital admission and functional decline in older community-dwelling adults attending primary care.Setting: 15 general practices (GPs) in Ireland.Participants: n=862, >= 70 years, community-dwellers followed-up for 2 years (2010-2012).Exposure at baseline: Five multimorbidity measures (disease counts, selected conditions counts, Charlson comorbidity index, RxRisk-V, medication counts) calculated using GP medical record and linked national pharmacy claims data.Primary outcomes: (1) Emergency admission and ambulatory care sensitive (ACS) admission (GP medical record) and (2) functional decline (postal questionnaire).Statistical analysis: Descriptive statistics and measure discrimination (c-statistic, 95% CIs), adjusted for confounders.Results: Median age was 77 years and 53% were women. Prevalent rates ranged from 37% to 91% depending on which measure was used to define multimorbidity. All measures demonstrated poor discrimination for the outcome of emergency admission (c-statistic range: 0.62, 0.65), ACS admission (c-statistic range: 0.63, 0.68) and functional decline (c-statistic range: 0.55, 0.61). Medication-based measures were equivalent to diagnosis-based measures.Conclusions: The choice of measure may have a significant impact on prevalent rates. Five multimorbidity measures demonstrated poor discrimination in predicting emergency admission and functional decline, with medication-based measures equivalent to diagnosis-based measures. Consideration of multimorbidity in isolation is insufficient for predicting these outcomes in community settings.