Meinck M, Lübke N, Ernst F
Kompetenz-Centrum Geriatrie des GKV-Spitzenverbandes und der Medizinischen Dienste , c/o MDK Nord, Hammerbrookstr. 5, 20097, Hamburg, Deutschland.
Z Gerontol Geriatr. 2012 Oct;45(7):647-57. doi: 10.1007/s00391-012-0302-x.
Due to demographics, characteristic multimorbidity in geriatric patients is resulting in increased social, medical, and healthcare challenges. Geriatric multimorbidity (GM) can be defined as the simultaneous occurrence of at least two diseases that require medical care with an interdisciplinary focus on independence in activities of daily living. Typical conditions of GM are, e.g., incontinence, cognitive impairment, frailty, and decubitus.
Part 2 of this study is based on claims data of 240,502 AOK insurants (AOK is one of the major health insurance companies of the German statutory health insurance system) aged ≥ 60 years with at least one admission to a hospital with a geriatric ward. Geriatric conditions (GCs) were ascertained in two ways: diagnoses from physicians in the ambulant care setting and diagnoses in a hospital setting in 2008. A total of 15 GC were assessed using diagnoses based on ICD-10 codes (as per suggestion from scientific geriatric societies). An insurant was defined as a person with GM, if he/she had at least two GCs.
The proportion of GCs in ambulant or inpatient diagnoses of 240,502 insurants varied significantly in most cases. For specific GCs, considerably higher proportions of ambulant diagnoses (e.g., pain, impairment of vision, or hearing) or for inpatient diagnoses (e.g., electrolyte or fluid metabolism disorders, malnutrition, incontinence) were identified. Only on rare occasions were small differences observed comparing the proportions of specific GCs in the diagnoses of the two different care sectors. This finding reduces considerably the accordance between the two care sectors with reference to the presence or absence of a GC for ambulant or inpatient diagnoses. The main agreement was with the non-coding of specific GCs, not with ambulant or inpatient diagnoses. Insurants with a geriatric hospital admission or certain care level (level ≥ 1) generally had higher proportions for specific GCs for inpatient and ambulant diagnoses than non-geriatric treated insurants or insurants without a certain care level. Of the geriatric treated insurants and those with certain care levels, 90% were characterized by the presence of GM for both ambulant or inpatient diagnoses. This percentage is remarkably higher than for patients who featured no geriatric treatment or had no certain care level.
The inclusion of ambulant diagnoses in addition to inpatient diagnosis offers comprehensive possibilities to identify insurants with GM in claims data. The contribution of the diagnoses of both care sectors for the identification of GC and GM varies with regard to attribute and insurant orientation. Furthermore, significant attribute-oriented overlap of insurants claiming geriatric treatments and insurants with certain care levels became visible, which can open new possibilities for simpler identification of a portion of patients with GM.
由于人口结构变化，老年患者特有的多种疾病并存现象给社会、医疗和卫生保健带来了越来越多的挑战。老年多病共存（GM）可定义为同时出现至少两种需要医疗护理的疾病，且跨学科关注日常生活活动中的独立性。GM的典型病症包括尿失禁、认知障碍、虚弱和褥疮等。
本研究的第二部分基于240,502名年龄≥60岁、至少有一次入住设有老年病房医院经历的德国法定医疗保险体系主要健康保险公司之一——AOK保险公司参保人的理赔数据。通过两种方式确定老年病症（GCs）：2008年门诊护理环境中医师的诊断以及医院环境中的诊断。根据科学老年学会的建议，基于国际疾病分类第十版（ICD - 10）编码使用诊断评估总共15种GC。如果参保人至少患有两种GC，则定义为患有GM的人。
在大多数情况下，240,502名参保人的门诊或住院诊断中GC的比例差异显著。对于特定的GC，发现门诊诊断（如疼痛、视力或听力障碍）或住院诊断（如电解质或液体代谢紊乱、营养不良、尿失禁）的比例要高得多。在比较两个不同护理部门诊断中特定GC的比例时，仅在极少数情况下观察到微小差异。这一发现大大降低了两个护理部门在门诊或住院诊断中GC存在与否方面的一致性。主要的一致性在于特定GC的未编码情况，而非门诊或住院诊断。入住老年医院或具有特定护理级别（级别≥1）的参保人，其特定GC在住院和门诊诊断中的比例通常高于未接受老年治疗的参保人或没有特定护理级别的参保人。在接受老年治疗的参保人和具有特定护理级别的参保人中，则有90%的人在门诊或住院诊断中表现为GM。这一比例明显高于未接受老年治疗或没有特定护理级别的患者。
除住院诊断外纳入门诊诊断，为在理赔数据中识别患有GM的参保人提供了全面的可能性。两个护理部门的诊断对GC和GM识别的贡献在属性和参保人导向方面存在差异。此外，接受老年治疗的参保人和具有特定护理级别的参保人在属性导向方面存在显著重叠，这为更简单地识别部分GM患者开辟了新的可能性。
