Measuring Frailty in Administrative Claims Data: Comparative Performance of Four Claims-Based Frailty Measures in the US Medicare Data
Measuring Frailty in Administrative Claims Data: Comparative Performance of Four Claims-Based Frailty Measures in the US Medicare Data
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DOI：
10.1093/gerona/glz224
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发表时间：
2020-06-01
影响因子：
5.1
通讯作者：
Glynn, Robert J.
中科院分区：
文献类型：
--
作者：
Kim, Dae Hyun;Patorno, Elisabetta;Glynn, Robert J.
背景：人们越来越努力地衡量美国联邦医疗保险数据的脆弱性。方法：这项横断面研究包括3097名社区居民的医疗保险服务费用受益人(平均年龄75.6岁)，他们参加了2008年的健康和退休研究考试。结果：基于声称的脆弱测量与脆弱表型呈正相关(第90百分位数：Davidoff为8.0%比41.3%；Faurot为5.9%比53.1%；西格尔为3.3%比48.0%；西格尔为3.3%比48.0%；2.9%比51.0%的Kim)和FI(第90个百分位数的平均值：大卫杜夫0.17比0.33；福罗0.13比0.37；西格尔0.12比0.31；Kim 0.10比0.37)。经年龄和性别调整的C统计量分别为0.73、0.74、0.73和0.78，与FI的偏相关系数分别为0.18、0.32、0.26和0.55。ADL依赖的结果相似(第90百分位数的患病率：Davidoff的3.7%比50.5%；Faurot的2.3%比55.0%；西格尔的3.0%比38.3%；Kim的2.3%比50.8%)。这些指数的年龄和性别调整后的C-统计量分别为0.79、0.80、0.74和0.81。结论：基于索赔的脆弱测量方法的选择会影响老年医疗保险数据中虚弱和残疾的识别。
Background: There has been increasing effort to measure frailty in the U.S. Medicare data. The performance of claims-based frailty measures has not been compared.Methods: This cross-sectional study included 3,097 community-dwelling fee-for-service Medicare beneficiaries (mean age 75.6 years) who participated in the 2008 Health and Retirement Study examination. Four claims-based frailty measures developed by Davidoff, Faurot, Segal, and Kim were compared against frailty phenotype, a deficit-accumulation frailty index (FI), and activities of daily living (ADL) dependence using Spearman correlation coefficients and C-statistics.Results: Claims-based frailty measures were positively associated with frailty phenotype (prevalence in 90th percentile: 8.0% vs 41.3% for Davidoff; 5.9% vs 53.1% for Faurot; 3.3% vs 48.0% for Segal; 2.9% vs 51.0% for Kim) and FI (mean in 90th percentile: 0.17 vs 0.33 for Davidoff; 0.13 vs 0.37 for Faurot; 0.12 vs 0.31 for Segal; 0.10 vs 0.37 for Kim). The age and sex-adjusted C-statistics for frailty phenotype for Davidoff, Faurot, Segal, and Kim indices were 0.73, 0.74, 0.73, and 0.78, respectively, and partial correlation coefficients with FI were 0.18, 0.32, 0.26, and 0.55, respectively. The results for ADL dependence were similar (prevalence in 90th percentile: 3.7% vs 50.5% for Davidoff; 2.3% vs 55.0% for Faurot; 3.0% vs 38.3% for Segal; 2.3% vs 50.8% for Kim). The age and sex-adjusted C-statistics for the indices were 0.79, 0.80, 0.74, and 0.81, respectively.Conclusions: The choice of a claims-based frailty measure can influence the identification of older adults with frailty and disability in Medicare data.