USE OF PHYSICAL PERFORMANCE MEASURES IN ROUTINE CLINICAL CARE

工作总结：本研究的目的是 制定性能测试协议， 临床设置，并确定常规的可行性 在门诊诊所环境中的性能测试。将 研究了这些信息是否可以用来识别那些 未来不良后果风险增加的老年人， 风险状态可能无法使用更传统的 临床评估。堪萨斯城退伍军人医疗中心的病人 中心和当地的HMO目前正在管理 性能测试时，他们看到的常规临床护理。他们 将在所有诊所访视时接受重复评估，以确定 功能衰退。进一步的后续行动和与脆弱性和 HMO记录被HMO用来评估 性能指标来预测一些不利的结果。 初步数据分析表明， 基线表现较差者死亡率较高， 医疗支出，更多的住院治疗，以及更多的使用 急诊室在将绩效指标与 评估工具目前正在使用的HMO的筛选 高风险使用医院的人，发现 性能测量增加了预测信息， 独立于所建立的筛选仪器。进一步工作 将识别随着时间推移表现下降的患者 并评估这种下降是否发生在缺乏主要 导致灾难性功能丧失的医疗事件。 证明一部分有业绩的人 在没有重大医疗事件的情况下下降提供了证据， 这些测量可用于识别功能下降， 否则可能会被临床医生遗漏。

Summary of Work: The purpose of this study is to develop protocols for performance testing that can be used in the clinical setting and to determine the feasibility of routine performance testing in the outpatient clinic setting. It will be examined whether this information can be used to identify those older persons at increased risk of future adverse outcomes whose risk status might not be appreciated using more conventional clinical assessment. Patients in both the Kansas City VA Medical Center and a local HMO are currently being administered performance tests when they are seen for routine clinical care. They will receive repeated assessments at all clinic visits to identify those with functional decline. Further follow-up and linkage to VA and HMO records are being used by HMO's to evaluate the ability of performance measures to predict a number of adverse outcomes. Preliminary data analyses have demonstrated that persons with poorer performance at baseline have higher mortality, greater medical expenditures, more hospitalizations, and higher use of emergency rooms. In comparing the performance measures to an assessment tool currently being used by HMO's to screen for persons at high risk of hospital utilization, it was found that the performance measures add predictive information that is independent of the estalbished screening instrument. Further work will identify patients who have a decline in performance over time and evaluate whether this decline occurred int he absence of major medical events that cause catastrophic loss of functioning. Demonstrating that a proportion of persons with performance decline do so without major medical events provides evidence that the measures can be used to identify declining functioning that might be otherwise missed by the clinician.