Measuring Multimorbidity: Selecting the Right Instrument for the Purpose and the Data Source.
Measuring Multimorbidity: Selecting the Right Instrument for the Purpose and the Data Source.
复制标题
DOI：
10.1097/mlr.0000000000001566
复制
发表时间：
2021-08-01
期刊：
影响因子：
3
通讯作者：
Klabunde CN
中科院分区：
文献类型：
--
作者：
Suls J;Bayliss EA;Berry J;Bierman AS;Chrischilles EA;Farhat T;Fortin M;Koroukian SM;Quinones A;Silber JH;Ward BW;Wei M;Young-Hyman D;Klabunde CN
与孤立的单一疾病相比，成年人患多重疾病（或患有多种慢性健康状况）的比例更高。研究人员、卫生保健提供者和卫生政策制定者发现，从许多现有的多发病措施中决定最适当的评估工具具有挑战性。目的：描述广泛的工具和数据来源可用于评估多病，并为选择适当的措施提供指导。设计：在2018年9月25日至26日由美国国立卫生研究院主办的特别专家研讨会期间，对仪器进行了审查并制定了指南。讲习班与会者确定了多重疾病测量的四个共同目的以及五个主要数据来源的优缺点：医疗记录/临床评估、行政索赔、公共卫生调查、患者报告和电子健康记录。参与者调查了15种工具和2个公共卫生数据系统，并描述了测量的特征、有效性和其他特征，这些特征为工具选择提供了信息。仪器选择指南包括建议将多重疾病测量的目的与测量方法和仪器相匹配，审查可用的数据源，并考虑情境和其他相关结构，以增强多重疾病的整体测量。通过适当的测量选择，结合数据来源和特殊考虑，充分捕捉代表性不足的种族/民族人群、儿童、患有多种不良儿童事件的个体和经历功能限制和其他老年综合征的老年人的多重疾病负担，可以提高多重疾病测量的准确性。综合电子健康记录系统的增加提供了通过其他数据源无法获得的新机会。
Adults have a higher prevalence of multimorbidity—or having multiple chronic health conditions—than having a single condition in isolation. Researchers, health care providers and health policy makers find it challenging to decide upon the most appropriate assessment tool from the many available multimorbidity measures. Objective: To describe a broad range of instruments and data sources available to assess multimorbidity and offer guidance about selecting appropriate measures. Design: Instruments were reviewed and guidance developed during a special expert workshop sponsored by the National Institutes of Health on September 25-26, 2018. Workshop participants identified four common purposes for multimorbidity measurement as well as the advantages and disadvantages of five major data sources: medical records/clinical assessments, administrative claims, public health surveys, patient reports, and electronic health records. Participants surveyed 15 instruments and 2 public health data systems, and described characteristics of the measures, validity, and other features that inform tool selection. Guidance on instrument selection includes recommendations to match the purpose of multimorbidity measurement to the measurement approach and instrument, review available data sources, and consider contextual and other related constructs to enhance overall measurement of multimorbidity. The accuracy of multimorbidity measurement can be enhanced with appropriate measurement selection, combining data sources and special considerations for fully capturing multimorbidity burden in underrepresented racial/ethnic populations, children, individuals with multiple Adverse Childhood Events and older adults experiencing functional limitations and other geriatric syndromes. The increased availability of comprehensive electronic health record systems offers new opportunities not available through other data sources.