A new simple primary care morbidity score predicted mortality and better explains between practice variations than the Charlson index
A new simple primary care morbidity score predicted mortality and better explains between practice variations than the Charlson index
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DOI：
10.1016/j.jclinepi.2012.10.012
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发表时间：
2013-04-01
影响因子：
7.2
通讯作者：
Cook, Derek G.
中科院分区：
文献类型：
--
作者：
Carey, Iain M.;Shah, Sunil M.;Cook, Derek G.
目的：调整发病率是很重要的，以确保公平的比较结果之间的患者群体和卫生保健提供者。在英国初级保健的质量和成果框架（QOF）提供了潜在的发展一个标准化的发病率评分为low-risk population.Study设计和设置：回顾性队列研究的653,780例患者年龄60岁或以上的注册与375的做法在2008年在一个大型的初级保健数据库（健康改善网络）。一半的做法被随机选择，以获得预测1年死亡率的发病率评分;其他评估预测performance.Results：9慢性疾病是强大的copredictors（风险比= >= 1.2）的死亡率独立于年龄和性别，产生高预测歧视（C-统计= 0.82）。一个人的QOF评分比Charlson指数（46%对32%）更能解释死亡率在实践中的变化。在实践水平，平均QOF得分与实践标准化死亡率比（r = 0.64），解释更多的变化，在实践中的死亡率比Charlson index.Conclusion：一个简单的9项评分来自常规的初级保健记录提供了一个发病率指数高度预测死亡率和实践之间的变化，在老年英国初级保健人群。这在研究和卫生保健结果监测中具有实用性，并且可以在其他初级和门诊护理环境中容易地实施。(C)2013 Elsevier Inc. All rights reserved.
Objectives: Adjustment for morbidity is important to ensure fair comparison of outcomes between patient groups and health care providers. The Quality and Outcomes Framework (QOF) in UK primary care offers potential for developing a standardized morbidity score for low-risk populations.Study Design and Setting: Retrospective cohort study of 653,780 patients aged 60 years or older registered with 375 practices in 2008 in a large primary care database (The Health Improvement Network). Half the practices were randomly selected to derive a morbidity score predicting 1-year mortality; the others assessed predictive performance.Results: Nine chronic conditions were robust copredictors (hazard ratio = >= 1.2) of mortality independent of age and sex, producing high predictive discrimination (c-statistic = 0.82). An individual's QOF score explained more between practice variation in mortality than the Charlson index (46% vs. 32%). At practice level, mean QOF score was strongly correlated with practice standardized mortality ratios (r = 0.64), explaining more variation in practice death rates than the Charlson index.Conclusion: A simple nine-item score derived from routine primary care recording provides a morbidity index highly predictive of mortality and between practice variation in older UK primary care populations. This has utility in research and health care outcome monitoring and can be easily implemented in other primary and ambulatory care settings. (C) 2013 Elsevier Inc. All rights reserved.