住院老年患者认知障碍的种族差异和记录情况。
Race and documentation of cognitive impairment in hospitalized older adults.
机构信息
College of Pharmacy, Purdue University, West Lafayette, Indiana; Center for Aging Research, Indiana University, Indianapolis, Indiana; Regenstrief Institute, Inc., Indiana University, Indianapolis, Indiana; Department of Pharmacy, Eskenazi Health, Indianapolis, Indiana.
出版信息
J Am Geriatr Soc. 2014 Mar;62(3):506-11. doi: 10.1111/jgs.12691. Epub 2014 Feb 27.
OBJECTIVES
To evaluate whether race influences agreement between screening results and documentation of cognitive impairment and delirium.
DESIGN
Secondary data analysis.
SETTING
An urban, public hospital and healthcare system.
PARTICIPANTS
Hospitalized older adults aged 65 and older admitted to general inpatient medical services evaluated for cognitive impairment (n = 851) and evaluated for delirium (n = 424).
MEASUREMENTS
Cognitive impairment and delirium were measured in each participant using the Short Portable Mental Status Questionnaire (SPMSQ) and the Confusion Assessment Method (CAM), respectively, as the reference identification method. Clinical documentation of cognitive impairment and delirium was defined according to the presence of International Classification of Diseases, Ninth Revision (ICD-9), codes from within 1 year before hospitalization through discharge for cognitive impairment or from hospital admission through discharge for delirium.
RESULTS
Two hundred ninety-four participants (34%) had cognitive impairment based on SPMSQ performance, and 163 (38%) had delirium based on CAM results. One hundred seventy-one (20%) of those with cognitive impairment had an ICD-9 code for cognitive impairment, whereas 92 (22%) of those with delirium had an ICD-9 code for delirium. After considering age, sex, education, socioeconomic status, chronic comorbidity, and severity of acute illness, of those who screened positive on the SPMSQ, African Americans had a higher adjusted odds ratio (AOR) than non-African Americans for clinical documentation of cognitive impairment (AOR = 1.66, 95% confidence interval (CI) = 0.95-2.89), and of those who screened negative on the SPMSQ, African Americans had higher odds of clinical documentation of cognitive impairment (AOR = 2.10, 95% CI = 1.17-3.78) than non-African Americans. There were no differences in clinical documentation rates of delirium between African Americans and non-African Americans.
CONCLUSION
Racial differences in coding for cognitive impairment may exist, resulting in higher documentation of cognitive impairment in African Americans screening positive or negative for cognitive impairment.
目的
评估种族是否会影响筛查结果与认知障碍和谵妄记录之间的一致性。
设计
二次数据分析。
地点
城市，公立医院和医疗保健系统。
参与者
年龄在 65 岁及以上，入住普通住院内科服务的老年住院患者，评估认知障碍（n=851）和谵妄（n=424）。
测量方法
使用简短便携精神状态问卷（SPMSQ）和意识模糊评估法（CAM）分别评估每位参与者的认知障碍和谵妄，SPMSQ 和 CAM 为参考识别方法。认知障碍和谵妄的临床记录根据认知障碍的国际疾病分类，第九版（ICD-9）住院前 1 年内至出院期间的代码，或谵妄的入院至出院期间的代码来定义。
结果
根据 SPMSQ 表现，294 名参与者（34%）有认知障碍，根据 CAM 结果，163 名参与者（38%）有谵妄。在有认知障碍的患者中，有 171 名（20%）有认知障碍的 ICD-9 编码，而在有谵妄的患者中，有 92 名（22%）有谵妄的 ICD-9 编码。在考虑年龄、性别、教育、社会经济地位、慢性合并症和急性疾病严重程度后，在 SPMSQ 筛查阳性的患者中，非裔美国人比非非裔美国人有更高的调整后优势比（AOR），用于认知障碍的临床记录（AOR=1.66，95%置信区间[CI] = 0.95-2.89），在 SPMSQ 筛查阴性的患者中，非裔美国人有更高的认知障碍临床记录的可能性（AOR=2.10，95%CI=1.17-3.78），而非非裔美国人。非裔美国人和非非裔美国人的谵妄临床记录率没有差异。
结论
认知障碍编码方面可能存在种族差异，导致筛查阳性或阴性的非裔美国人认知障碍记录更高。
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