社区居住老年人医疗服务利用情况的自我报告：一项前瞻性队列研究。
Self-report of healthcare utilization among community-dwelling older persons: a prospective cohort study.
作者信息
van Dalen Marlies T, Suijker Jacqueline J, MacNeil-Vroomen Janet, van Rijn Marjon, Moll van Charante Eric P, de Rooij Sophia E, Buurman Bianca M
机构信息
Department of General Practice, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Department of Internal medicine, Geriatric section, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
出版信息
PLoS One. 2014 Apr 7;9(4):e93372. doi: 10.1371/journal.pone.0093372. eCollection 2014.
BACKGROUND
Self-reported data are often used for estimates on healthcare utilization in cost-effectiveness studies.
OBJECTIVE
To analyze older adults' self-report of healthcare utilization compared to data obtained from the general practitioners' (GP) electronic medical record (EMR) and to study the differences in healthcare utilization between those who completed the study, those who did not respond, and those lost to follow-up.
METHODS
A prospective cohort study was conducted among community-dwelling persons aged 70 years and above, without dementia and not living in a nursing home. Self-reporting questionnaires were compared to healthcare utilization data extracted from the EMR at the GP-office.
RESULTS
Overall, 790 persons completed questionnaires at baseline, median age 75 years (IQR 72-80), 55.8% had no disabilities in (instrumental) activities of daily living. Correlations between self-report data and EMR data on healthcare utilization were substantial for 'hospitalizations' and 'GP home visits' at 12 months intraclass correlation coefficient 0.63 (95% CI; 0.58-0.68). Compared to the EMR, self-reported healthcare utilization was generally slightly over-reported. Non-respondents received more GP home visits (p<0.05). Of the participants who died or were institutionalized 62.2% received 2 or more home visits (p<0.001) and 18.9% had 2 or more hospital admissions (p<0.001) versus respectively 18.6% and 3.9% of the participants who completed the study. Of the participants lost to follow-up for other reasons 33.0% received 2 or more home visits (p<0.01) versus 18.6 of the participants who completed the study.
CONCLUSIONS
Self-report of hospitalizations and GP home visits in a broadly 'healthy' community-dwelling older population seems adequate and efficient. However, as people become older and more functionally impaired, collecting healthcare utilization data from the EMR should be considered to avoid measurement bias, particularly if the data will be used to support economic evaluation.
背景
在成本效益研究中，自我报告数据常被用于估算医疗保健利用率。
目的
分析老年人对医疗保健利用率的自我报告，并与从全科医生（GP）电子病历（EMR）中获取的数据进行比较，同时研究完成研究的人群、未回应者以及失访者在医疗保健利用率方面的差异。
方法
对70岁及以上、无痴呆且不住在养老院的社区居民进行前瞻性队列研究。将自我报告问卷与从GP诊所的EMR中提取的医疗保健利用率数据进行比较。
结果
总体而言，790人在基线时完成了问卷，中位年龄75岁（四分位间距72 - 80），55.8%的人在（工具性）日常生活活动中无残疾。自我报告数据与EMR数据在医疗保健利用率方面的相关性在“住院”和“GP家访”方面较强，12个月的组内相关系数为0.63（95%置信区间；0.58 - 0.68）。与EMR相比，自我报告的医疗保健利用率通常略有高估。未回应者接受的GP家访更多（p<0.05）。在死亡或被机构收容的参与者中，62.2%接受了2次或更多次家访（p<0.001），18.9%有2次或更多次住院（p<0.001），而完成研究的参与者中这一比例分别为18.6%和3.9%。在因其他原因失访的参与者中，33.0%接受了2次或更多次家访（p<0.01），而完成研究的参与者中这一比例为18.6%。
结论
在大致“健康”的社区居住老年人群中，住院和GP家访的自我报告似乎是充分且有效的。然而，随着人们年龄增长且功能障碍增多，应考虑从EMR中收集医疗保健利用率数据以避免测量偏差，特别是如果这些数据将用于支持经济评估。
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