Screening of older community-dwelling people at risk for death and hospitalization: The assistenza socio-sanitaria in italia project
Screening of older community-dwelling people at risk for death and hospitalization: The assistenza socio-sanitaria in italia project
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DOI：
10.1111/j.1532-5415.2007.01446.x
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发表时间：
2007-12-01
影响因子：
6.3
通讯作者：
Di Bari, Mauro
中科院分区：
文献类型：
--
作者：
Mazzaglia, Giampiero;Roti, Lorenzo;Di Bari, Mauro
目的：根据初级保健医生（pcp）可获得的信息，开发和验证死亡率和住院预后工具。设计:基于人群的队列研究。基线预测指标为患者人口统计数据、关于功能状态和一般健康状况的七项问卷、使用五种或五种以上药物以及既往住院情况。环境：社区研究。参与者：在2470名受试者中制定了预后指标，并在2926名受试者中进行了验证，这些受试者均居住在社区，年龄在65岁及以上，并从意大利佛罗伦萨的98家pcp名册中随机抽样。指标：15个月死亡率和住院率。结果：从logistic回归模型中得到两个评分，并将参与者分为四组。在模型1中，基于7项问卷，最低风险组（0-1分）死亡率为0.8%，最高风险组（>= 3分）死亡率为9.4%，住院率为12.4% ~ 29.3%；受试者工作特征曲线下面积（AUC）分别为0.75和0.60。在模型2中，考虑到药物使用情况和既往住院情况，最低风险组和最高风险组的死亡率和住院率分别为0.3% ~ 8.2%和8.1% ~ 29.7%；仅住院时AUC显著升高（0.67）。结论：利用pcp可及时获得的信息，两项指标可以很容易地预测社区老年居民的死亡和住院情况。这些工具可能有助于指导临床护理和有针对性的干预措施，以减少老年人对医院护理的需求。
OBJECTIVES: To develop and validate mortality and hospitalization prognostic tools based upon information readily available to primary care physicians (PCPs).DESIGN: Population-based cohort study. Baseline predictors were patient demographics, a seven-item questionnaire on functional status and general health, use of five or more drugs, and previous hospitalization.SETTING: Community-based study.PARTICIPANTS: Prognostic indexes were developed in 2,470 subjects and validated in 2,926 subjects, all community-dwelling, aged 65 and older, and randomly sampled from the rosters of 98 PCPs in Florence, Italy.MEASUREMENTS: Fifteen-month mortality and hospitalization.RESULTS: Two scores were derived from logistic regression models and used to stratify participants into four groups. With Model 1, based upon the seven-item questionnaire, mortality rate ranged from 0.8% in the lowest-risk group (0-1 point) to 9.4% in the highest risk group (>= 3 points), and hospitalization rate ranged from 12.4% to 29.3%; area under the receiver operating characteristic curves ( AUC) was 0.75 and 0.60, respectively. With Model 2, considering also drug use and previous hospitalization, mortality and hospitalization rates ranged from 0.3% to 8.2% and from 8.1% to 29.7%, for the lowest-risk to the highest-risk group; the AUC increased significantly only for hospitalization (0.67).CONCLUSION: Prediction of death and hospitalization in older community-dwelling people can be easily obtained with two indexes using information promptly available to PCPs. These tools might be useful for guiding clinical care and targeting interventions to reduce the need for hospital care in older persons.