Dr Foster global frailty score: an international retrospective observational study developing and validating a risk prediction model for hospitalised older persons from administrative data sets
Dr Foster global frailty score: an international retrospective observational study developing and validating a risk prediction model for hospitalised older persons from administrative data sets
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DOI：
10.1136/bmjopen-2018-026759
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发表时间：
2019-06-01
期刊：
影响因子：
2.9
通讯作者：
Hopper, Adrian
中科院分区：
文献类型：
--
作者：
Soong, John T. Y.;Kaubryte, Jurgita;Hopper, Adrian
目的本研究的目的是调查福斯特博士全球比较者(GC)国际数据库中脆弱编码的流行率。然后，我们的目标是开发和验证一个基于虚弱症状的风险预测模型，使用GC数据集对关键结果进行预测。设计一个来自GC国际管理数据的75岁以上患者数据的回溯性队列分析。基于七个虚弱综合征组及其与结果指标的关系的初步分析，开发了一个风险预测模型。然后，为每个综合症组创建一个权重，并将其相加，以产生Dr Foster Global Fililty评分。将预测能力得分与已建立的预后协同模型(Elixhauser)进行比较，并在另一个行政数据库医院流行病学统计(2011-2015)上进行外部验证。设置来自欧洲、澳大利亚、英国和美国9个国家的34家医院。结果GC数据库中的670万份患者记录中，140万份(20%)来自75岁或以上的患者。不同国家和医院对虚弱症状的编码有显著差异。虚弱综合征在2%到24%的患者法术中被编码。跌倒和骨折是最常见的综合征编码(24%)。福斯特博士全球脆弱评分与住院死亡率、30天非选择性再入院和长时间住院显著相关。该评分具有显著的预测能力，超过了其他已知的预测老年人不良结局的指标，如合并症和实际年龄。选修组的评分预测能力高于非选修组，可能反映了低视力状态下表现的改善。结论虚弱综合征可以在国际二级护理管理数据集中进行编码。福斯特博士的全球脆弱性评分显著预测了关键结果。这一方法可在国际上用于老年人的病例组合调整。
Objectives This study aimed to examine the prevalence of frailty coding within the Dr Foster Global Comparators (GC) international database. We then aimed to develop and validate a risk prediction model, based on frailty syndromes, for key outcomes using the GC data set.Design A retrospective cohort analysis of data from patients over 75 years of age from the GC international administrative data. A risk prediction model was developed from the initial analysis based on seven frailty syndrome groups and their relationship to outcome metrics. A weighting was then created for each syndrome group and summated to create the Dr Foster Global Frailty Score. Performance of the score for predictive capacity was compared with an established prognostic comorhidity model (Elixhauser) and tested on another administrative database Hospital Episode Statistics (2011-2015), for external validation.Setting 34 hospitals from nine countries across Europe, Australia, the UK and USA.Results Of 6.7 million patient records in the GC database, 1.4 million (20%) were from patients aged 75 years or more. There was marked variation in coding of frailty syndromes between countries and hospitals. Frailty syndromes were coded in 2% to 24% of patient spells. Falls and fractures was the most common syndrome coded (24%). The Dr Foster Global Frailty Score was significantly associated with in-hospital mortality, 30-day non-elective readmission and long length of hospital stay. The score had significant predictive capacity beyond that of other known predictors of poor outcome in older persons, such as comorbidity and chronological age. The score's predictive capacity was higher in the elective group compared with non-elective, and may reflect improved performance in lower acuity states.Conclusions Frailty syndromes can be coded in international secondary care administrative data sets. The Dr Foster Global Frailty Score significantly predicts key outcomes. This methodology may be feasibly utilised for case-mix adjustment for older persons internationally.