Comorbidity Assessments Based on Patient Report: Results From the Veterans Health Study
Comorbidity Assessments Based on Patient Report: Results From the Veterans Health Study
复制标题
DOI：
10.1097/00004479-200407000-00011
复制
发表时间：
2004-07
影响因子：
2.3
通讯作者：
A. Selim;G. Fincke;X. Ren;Austin Lee;W. Rogers;Donald R. Miller;K. Skinner;M. Linzer;L. Kazis
中科院分区：
文献类型：
--
作者：
A. Selim;G. Fincke;X. Ren;Austin Lee;W. Rogers;Donald R. Miller;K. Skinner;M. Linzer;L. Kazis
翻译后摘要：本研究的目的是开发一个自我报告的措施，患者的共病，可以很容易地管理在门诊护理设置，这将提高他们的健康相关的生活质量和利用卫生服务的评估。数据分析来自退伍军人健康研究，这是一项对接受退伍军人管理局（VA）门诊护理的患者健康结局的观察性研究。1993年8月至1996年3月期间在大波士顿地区的4家VA门诊诊所接受门诊护理服务的患者有资格入选。在招募的4137名患者中，有2425人参加了退伍军人健康研究，响应率为59%。参与者邮寄了一份健康相关的生活质量问卷，即医学结局研究简表健康调查（SF-36）。他们还安排了一次面对面的访谈，当时他们完成了一份病史问卷。我们开发了一个共病指数（CI），其中包括30个自我报告的医疗条件（物理CI）和6个自我报告的精神条件（精神CI）。身体CI和心理CI与所有SF-36量表显著相关，分别解释了SF-36的身体成分汇总和心理成分汇总方差的24%和36%。这两个指数也是未来门诊就诊和死亡率的重要预测因子。CI是健康状况、门诊就诊和死亡率的独立预测因子。它的使用似乎是一种实用的方法，病例组合调整，以解释在观察性研究的医疗质量的共病的差异。它可以以相对较低的成本向大量患者群体施用。这种方法可能是特别有价值的临床医生和研究人员感兴趣的人群为基础的研究，病例组合调整，和临床试验。
Abstract:The objective of the study was to develop a self-reported measure of patients' comorbid illnesses that could be readily administered in ambulatory care settings and that would improve assessment of their health-related quality of life and utilization of health services. Data were analyzed from the Veterans Health Study, an observational study of health outcomes in patients receiving Veterans Administration (VA) ambulatory care. Patients who received ambulatory care services in 4 VA outpatient clinics in the greater Boston area between August 1993 and March 1996 were eligible for inclusion. Among the 4137 patients recruited, 2425 participated in the Veterans Health Study, representing a response rate of 59%. Participants were mailed a health-related quality of life questionnaire, the Medical Outcomes Study Short Form Health Survey (SF-36). They were also scheduled for an in-person interview at which time they completed a medical history questionnaire. We developed a comorbidity index (CI) that included 30 self-reported medical conditions (physical CI) and 6 self-reported mental conditions (mental CI). The physical CI and the mental CI were significantly associated with all SF-36 scales and explained 24% and 36%, respectively, of the variance in the physical component summary and the mental component summary of the SF-36. Both indexes were also significant predictors of future outpatient visits and mortality. The CI is an independent predictor of health status, outpatient visits, and mortality. Its use appears to be a practical approach to case-mix adjustment to account for differences in comorbid illnesses in observational studies of the quality of healthcare. It can be administered to large patient populations at relatively low cost. This method may be particularly valuable for clinicians and researchers interested in population-based studies, case-mix adjustment, and clinical trials.