College of Human Medicine, Clinical Center Building, Michigan State University, 788 Service Road, Room B329, East Lansing, MI 48824, USA.
BMC Health Serv Res. 2012 Nov 14;12:398. doi: 10.1186/1472-6963-12-398.
The search for a reliable, valid and cost-effective comorbidity risk adjustment method for outcomes research continues to be a challenge. The most widely used tool, the Charlson Comorbidity Index (CCI) is limited due to frequent missing data in medical records and administrative data. Patient self-report data has the potential to be more complete but has not been widely used. The purpose of this study was to evaluate the performance of the Self-Administered Comorbidity Questionnaire (SCQ) to predict functional capacity, quality of life (QOL) health outcomes compared to CCI medical records data.
An SCQ-score was generated from patient interview, and the CCI score was generated by medical record review for 525 patients hospitalized for Acute Coronary Syndrome (ACS) at baseline, three months and eight months post-discharge. Linear regression models assessed the extent to which there were differences in the ability of comorbidity measures to predict functional capacity (Activity Status Index [ASI] scores) and quality of life (EuroQOL 5D [EQ5D] scores).
The CCI (R2 = 0.245; p = 0.132) did not predict quality of life scores while the SCQ self-report method (R2 = 0.265; p < 0.0005) predicted the EQ5D scores. However, the CCI was almost as good as the SCQ for predicting the ASI scores at three and six months and performed slightly better in predicting ASI at eight-month follow up (R2 = 0.370; p < 0.0005 vs. R2 = 0.358; p < 0.0005) respectively. Only age, gender, family income and Center for Epidemiologic Studies-Depression (CESD) scores showed significant association with both measures in predicting QOL and functional capacity.
Although our model R-squares were fairly low, these results show that the self-report SCQ index is a good alternative method to predict QOL health outcomes when compared to a CCI medical record score. Both measures predicted physical functioning similarly. This suggests that patient self-reported comorbidity data can be used for predicting physical functional capacity and QOL and can serve as a reliable risk adjustment measure. Self-report comorbidity data may provide a cost-effective alternative method for risk adjustment in clinical research, health policy and organizational improvement analyses.
Clinical Trials.gov NCT00416026.
寻找一种可靠、有效且具有成本效益的合并症风险调整方法，以用于进行结果研究，这一问题仍然存在挑战。最广泛使用的工具是 Charlson 合并症指数（CCI），但由于在医疗记录和行政数据中经常出现缺失数据，该工具受到了限制。患者的自我报告数据可能更完整，但尚未得到广泛应用。本研究的目的是评估自我管理合并症问卷（SCQ）在预测功能能力和健康相关生活质量（QOL）结局方面的表现，与 CCI 医疗记录数据相比。
对 525 名因急性冠状动脉综合征（ACS）住院的患者进行基线、三个月和八个月的随访，通过患者访谈生成 SCQ 评分，并通过医疗记录审查生成 CCI 评分。线性回归模型评估了这些合并症测量方法在预测功能能力（活动状态指数 [ASI] 评分）和生活质量（欧洲五维健康量表 [EQ5D] 评分）方面的能力差异。
CCI（R2=0.245；p=0.132）不能预测生活质量评分，而 SCQ 自我报告方法（R2=0.265；p<0.0005）则可以预测 EQ5D 评分。然而，CCI 在预测三个月和六个月时的 ASI 评分方面与 SCQ 一样好，在预测八个月时的 ASI 评分方面表现稍好（R2=0.370；p<0.0005 与 R2=0.358；p<0.0005）。只有年龄、性别、家庭收入和流行病学研究中心抑郁量表（CESD）评分在预测 QOL 和功能能力方面与两种方法均显著相关。
尽管我们的模型 R 平方值相当低，但这些结果表明，与 CCI 医疗记录评分相比，自我报告的 SCQ 指数是预测 QOL 健康结局的一种较好的替代方法。这两种方法对身体功能的预测效果相似。这表明患者自我报告的合并症数据可用于预测身体功能能力和 QOL，并可作为可靠的风险调整措施。自我报告的合并症数据可能为临床研究、卫生政策和组织改进分析提供一种具有成本效益的风险调整替代方法。
ClinicalTrials.gov NCT00416026。
