From the Department of Public Health, College of Health Sciences, Arcadia University, Glenside, Pennsylvania (HFM); and Center for Clinical Epidemiology and Biostatistics (JEK, PLK, DX, HRB), and Departments of Physical Medicine and Rehabilitation (MGS) and Family Medicine and Community Health (HRB), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Am J Phys Med Rehabil. 2018 Oct;97(10):698-707. doi: 10.1097/PHM.0000000000000942.
We sought to develop a risk scoring system for predicting functional deterioration, institutionalization, and mortality. Identifying predictors of poor health outcomes informs clinical decision-making, service provision, and policy development to address the needs of persons at greatest risk for poor health outcomes.
This is a cohort study with 21,257 community-dwelling Medicare beneficiaries 65 yrs and older who participated in the 2001-2008 Medicare Current Beneficiary Survey. Derivation of the model was conducted in 60% of the sample and validated in the remaining 40%. Multinomial logistic regression model generated β coefficients, which were used to create a risk scoring system. Our outcome was instrumental activity of daily living stage transitions (stable/improved function and functional deterioration), institutionalization, or mortality for 2 yrs of follow-up.
A total of 18 factors were identified for functional deterioration (P < 0.05). In the derivation cohort, the likelihood of functional deterioration ranged from 6.27% to 33.51%, risk of institutionalization from 0.07% to 12.13%, and risk of mortality from 2.13% to 31.83%, in comparison with stable/improved function.
A risk scoring system predicting Medicare beneficiaries' risk of functional deterioration, institutionalization, and mortality based on demographic and clinical indicators may feasibly be developed with implications for healthcare delivery.
我们旨在开发一种风险评分系统，以预测功能恶化、住院和死亡。识别健康结果不良的预测因素可以为临床决策、服务提供和政策制定提供信息，以满足健康结果最差风险人群的需求。
这是一项队列研究，共有 21257 名 65 岁及以上的居住在社区的医疗保险受益人参加了 2001-2008 年医疗保险当前受益人调查。模型的推导在样本的 60%中进行，并在剩余的 40%中进行验证。多元逻辑回归模型生成了β系数，用于创建风险评分系统。我们的结果是 2 年随访期间的日常生活活动工具性功能阶段转变（稳定/改善功能和功能恶化）、住院或死亡。
共确定了 18 个功能恶化的因素（P < 0.05）。在推导队列中，功能恶化的可能性范围为 6.27%至 33.51%，住院的可能性范围为 0.07%至 12.13%，死亡率为 2.13%至 31.83%，与稳定/改善功能相比。
一种基于人口统计学和临床指标预测医疗保险受益人功能恶化、住院和死亡风险的风险评分系统可能可行，对医疗保健的提供具有重要意义。
