A CHRONIC DISEASE SCORE WITH EMPIRICALLY DERIVED WEIGHTS
A CHRONIC DISEASE SCORE WITH EMPIRICALLY DERIVED WEIGHTS
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DOI：
10.1097/00005650-199508000-00004
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发表时间：
1995-08-01
期刊：
影响因子：
3
通讯作者：
SIMON, GE
中科院分区：
文献类型：
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作者：
CLARK, DO;VONKORFF, M;SIMON, GE
在6个月期间用于治疗和管理慢性病的不同类型的药物被用于慢性病评分的细化和验证。处方数据，除了年龄和性别，被用来开发一个慢性病评分的基础上经验得出的权重为三个结果：总成本，门诊费用，和初级保健访问。将修订后的慢性病评分预测卫生保健利用、费用、住院和死亡率的能力与早期版本的慢性病评分（原始）进行比较，后者是通过对疾病严重程度的临床判断得出的。慢性病评分的预测有效性也进行了比较，门诊护理组，利用门诊诊断，形成相互排斥的诊断类别。使用随机抽取的250，000名18岁及以上的管理式护理登记者的一半样本，对基于6个月期间和6个月前瞻性期间（即，慢性病评分或门诊护理组衍生期后的6个月期间）的模型进行估计。其余一半的入组人群用作验证样本。修订后的慢性病评分显示，与原始慢性病评分相比，估计和预测有所改善。相反，通过修订后的慢性病评分与门诊护理组之间的差异进行前瞻性解释的差异很小。与门诊护理组相比，修订后的慢性病评分是一个更好的死亡率预测因子。修订后的慢性病评分和门诊护理组的组合仅显示出比单独使用任何一种更高的预测能力。这些结果表明，修订后的慢性病评分和门诊护理组与经验得出的权重提供了更好的预测医疗保健利用和成本，以及住院和死亡率，年龄和性别。我们建议将修订后的慢性病评分与总费用权重一起作为严重程度的衡量标准，因为与门诊费用和初级保健就诊权重相比，其在预测死亡率方面具有相对优势。
Different types of medication prescribed during a 6-month period for the treatment and management of chronic conditions were utilized in the refinement and validation of a chronic disease score. Prescription data, in addition to age and sex, were utilized to develop a chronic disease score based on empirically derived weights for each of three outcomes: total cost, outpatient cost, and primary care visits. The ability of the revised chronic disease score to predict health care utilization, costs, hospitalization, and mortality was compared to an earlier version of the chronic disease score (original) that was derived through clinical judgments of disease severity. The predictive validity of the chronic disease score is also compared to ambulatory care groups, which utilize outpatient diagnoses to form mutually exclusive diagnostic categories. Models based on a concurrent 6-month period and a 6-month prospective period (ie, the 6-month period after the chronic disease score or ambulatory care group derivation period) were estimated using a random one half sample of 250,000 managed-care enrollees aged 18 and older. The remaining one half of the enrollee population was used as a validation sample. The revised chronic disease score showed improved estimation and prediction over the original chronic disease score. The difference in variance explained prospectively by the revised chronic disease score versus the ambulatory care groups, conversely, was small. The revised chronic disease score was a better predictor of mortality than the ambulatory care groups. The combination of revised chronic disease score and ambulatory care groups showed only marginally greater predictive power than either one alone. These results suggest that the revised chronic disease score and ambulatory care groups with empirically derived weights provide improved prediction of health care utilization and costs, as well as hospitalization and mortality, over age and sex alone. We recommend the revised chronic disease score with total cost weights for general use as a severity measure because of its relative advantage in predicting mortality compared to the outpatient cost and primary care visit weights.