Framework for evaluating disease severity measures in older adults with comorbidity
Framework for evaluating disease severity measures in older adults with comorbidity
复制标题
DOI：
10.1093/gerona/62.3.286
复制
发表时间：
2007-03-01
影响因子：
5.1
通讯作者：
Fried, Linda P.
中科院分区：
文献类型：
--
作者：
Boyd, Cynthia M.;Weiss, Carlos O.;Fried, Linda P.
背景。出于研究和临床决策目的，考虑并发疾病对健康和功能状态的影响对于老年人尤其重要。尽管已经开发出了对个体疾病和病症的严重程度进行分类的方法，但这些分类系统的实用性尚未在存在多种病症的情况下进行评估。我们提出了一个评估常见慢性病严重程度分类系统的框架。该框架评估： (a) 分类系统的目标或目的； (b) 严重程度分级的生理和/或功能标准； (c) 系统的潜在可靠性和有效性与分类相关的负担和成本相平衡。结果。对个体疾病的严重程度进行分类的方法最初并不是为了研究合并症而设计的。因此，它们在目标、涵盖的生理系统、严重程度表征、可靠性和有效性以及成本和负担方面存在很大差异。使用不同的严重程度分类系统来解释患有多种疾病的患者的不同疾病严重程度，或者评估总体疾病负担可能具有挑战性。结论。大多数严重程度分类方法不足以解决合并症。尽管如此，仔细使用一些现有方法并改进其他方法可能会促进对多种疾病患者的共病以及诊断和治疗方法的研究。
Background. Accounting for the influence of concurrent conditions on health and functional status for both research and clinical decision-making purposes is especially important in older adults. Although approaches to classifying severity of individual diseases and conditions have been developed, the utility of these classification systems has not been evaluated in the presence of multiple conditions.Methods. We present a framework for evaluating severity classification systems for common chronic diseases. The framework evaluates the: (a) goal or purpose of the classification system; (b) physiological and/or functional criteria for severity graduation; and (c) potential reliability and validity of the system balanced against burden and costs associated with classification.Results. Approaches to severity classification of individual diseases were not originally conceived for the study of comorbidity. Therefore, they vary greatly in terms of objectives, physiological systems covered, level of severity characterization, reliability and validity, and costs and burdens. Using different severity classification systems to account for differing levels of disease severity in a patient with multiple diseases, or, assessing global disease burden may be challenging.Conclusions. Most approaches to severity classification are not adequate to address comorbidity. Nevertheless, thoughtful use of some existing approaches and refinement of others may advance the study of comorbidity and diagnostic and therapeutic approaches to patients with multimorbidity.