Wallace Emma, McDowell Ronald, Bennett Kathleen, Fahey Tom, Smith Susan M
HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland.
Population Health Sciences Division, Royal College of Surgeons of Ireland (RCSI), Dublin, Ireland.
BMJ Open. 2016 Sep 20;6(9):e013089. doi: 10.1136/bmjopen-2016-013089.
Multimorbidity, defined as the presence of 2 or more chronic medical conditions in an individual, is associated with poorer health outcomes. Several multimorbidity measures exist, and the challenge is to decide which to use preferentially in predicting health outcomes. The study objective was to compare the performance of 5 count-based multimorbidity measures in predicting emergency hospital admission and functional decline in older community-dwelling adults attending primary care.
15 general practices (GPs) in Ireland.
n=862, ≥70 years, community-dwellers followed-up for 2 years (2010-2012). Exposure at baseline: Five multimorbidity measures (disease counts, selected conditions counts, Charlson comorbidity index, RxRisk-V, medication counts) calculated using GP medical record and linked national pharmacy claims data.
(1) Emergency admission and ambulatory care sensitive (ACS) admission (GP medical record) and (2) functional decline (postal questionnaire).
Descriptive statistics and measure discrimination (c-statistic, 95% CIs), adjusted for confounders.
Median age was 77 years and 53% were women. Prevalent rates ranged from 37% to 91% depending on which measure was used to define multimorbidity. All measures demonstrated poor discrimination for the outcome of emergency admission (c-statistic range: 0.62, 0.65), ACS admission (c-statistic range: 0.63, 0.68) and functional decline (c-statistic range: 0.55, 0.61). Medication-based measures were equivalent to diagnosis-based measures.
The choice of measure may have a significant impact on prevalent rates. Five multimorbidity measures demonstrated poor discrimination in predicting emergency admission and functional decline, with medication-based measures equivalent to diagnosis-based measures. Consideration of multimorbidity in isolation is insufficient for predicting these outcomes in community settings.
多病共存定义为个体存在两种或更多慢性疾病，与较差的健康结局相关。现有多种多病共存测量方法，而挑战在于决定在预测健康结局时优先使用哪种方法。本研究的目的是比较5种基于计数的多病共存测量方法在预测老年社区初级保健患者急诊入院和功能衰退方面的表现。
爱尔兰的15家全科诊所（GPs）。
n = 862名，年龄≥70岁，社区居民，随访2年（2010 - 2012年）。基线暴露：使用全科医生病历和关联的国家药房索赔数据计算的5种多病共存测量方法（疾病计数、选定疾病计数、Charlson合并症指数、RxRisk-V、药物计数）。
（1）急诊入院和门诊护理敏感（ACS）入院（全科医生病历）以及（2）功能衰退（邮寄问卷）。
描述性统计和测量辨别力（c统计量，95%置信区间），对混杂因素进行校正。
中位年龄为77岁，53%为女性。患病率根据用于定义多病共存的测量方法不同，范围在37%至91%之间。所有测量方法在预测急诊入院结局（c统计量范围：0.62，0.65）、ACS入院（c统计量范围：0.63，0.68）和功能衰退（c统计量范围：0.55，0.61）方面辨别力都较差。基于药物的测量方法与基于诊断的测量方法相当。
测量方法的选择可能对患病率有显著影响。5种多病共存测量方法在预测急诊入院和功能衰退方面辨别力较差，基于药物的测量方法与基于诊断的测量方法相当。在社区环境中，单独考虑多病共存不足以预测这些结局。
