Development of a Claims-based Frailty Indicator Anchored to a Well-established Frailty Phenotype.
Development of a Claims-based Frailty Indicator Anchored to a Well-established Frailty Phenotype.
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DOI：
10.1097/mlr.0000000000000729
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发表时间：
2017-07
期刊：
影响因子：
3
通讯作者：
Varadhan R
中科院分区：
文献类型：
--
作者：
Segal JB;Chang H-Y;Du Y;Walston JD;Carlson MC;Varadhan R
Fried 等人描述了心血管健康研究 (CHS) 中测量的虚弱表型。当存在以下 3 种或更多情况时，这种表型就会显现出来：握力低、能量低、醒来速度慢、体力活动少或无意的体重减轻。我们试图仅使用行政索赔数据来近似虚弱表型，以便能够在不进行身体表现测量的情况下评估虚弱程度。我们使用了与参与者医疗保险索赔相关的 CHS 队列数据。参考标准是在第 5 次和第 9 次就诊时测量的虚弱表型。通过惩罚逻辑回归，我们开发了一个简约指数，用于使用诊断的线性组合来预测虚弱表型，并结合索赔数据进行操作。我们通过检查衰弱指数预测常见衰老相关结果（包括住院、残疾和死亡）的效果来评估其预测有效性。来自 4 个临床中心的 4,454 名 CHS 参与者。 84% 是白人，58% 是女性，入学时的平均年龄为 72 岁。大约 11% 的人身体虚弱。该模型的 ROC 曲线下面积为 0.75，可同时预测虚弱表型。在根据年龄和性别进行调整的模型中，基于索赔的虚弱指数 (CFI) 显着预测了死亡 [比值比 1.84]、死亡时间 [危险比 1.71]、住院次数 [发生率比 1.74] 和疗养院入院次数 [OR 1.47]。仅索赔数据就可用于将个人分类为虚弱和非虚弱。 CFI 可用于大型数据集的研究，以进行混杂调整或风险预测。该指标还可用于应急准备，以识别体弱个体较多的区域。
Fried et al described a frailty phenotype measured in the Cardiovascular Health Study (CHS). This phenotype is manifest when 3 or more of the following are present: low grip strength, low energy, slowed waking speed, low physical activity, or unintentional weight loss. We sought to approximate frailty phenotype using only administrative claims data in order to enable frailty to be assessed without physical performance measures. We used the CHS cohort data linked to participants Medicare claims. The reference standard was the frailty phenotype measured at visits 5 and 9. With penalized logistic regression, we developed a parsimonious index for predicting the frailty phenotype using a linear combination of diagnoses, operationalized with claims data. We assessed the predictive validity of frailty index by examining how well it predicted common aging-related outcomes including hospitalization, disability and death. There were 4,454 CHS participants from 4 clinical sites. 84% were white, 58% were women and their mean age was 72 years at enrollment. Approximately 11% of the cohort was frail. The model had an area under the ROC curve of 0.75 to concurrently predict a frailty phenotype. This Claims-based Frailty Index (CFI) significantly predicted death [Odds-Ratio 1.84], time to death [Hazard-Ratio 1.71], number of hospital admissions [Incidence Rate-Ratio 1.74], and nursing home admission [OR 1.47] in models adjusted for age and sex. Claims data alone can be used to classify individuals as frail and non-frail. The CFI might be used in research with large datasets for confounding adjustment or risk prediction. The indicator might also be used for emergency preparedness for identification of regions enriched with frail individuals.