Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor, Michigan and Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan.
Division of Geriatric and Palliative Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan.
J Am Geriatr Soc. 2018 Jul;66(6):1195-1200. doi: 10.1111/jgs.15360. Epub 2018 Apr 17.
To compare the accuracy of and factors affecting the accuracy of self-reported fall-related injuries (SFRIs) with those of administratively obtained FRIs (AFRIs).
Retrospective observational study SETTING: United States PARTICIPANTS: Fee-for-service Medicare beneficiaries aged 65 and older (N=47,215).
We used 24-month self-report recall data from 2000-2012 Health and Retirement Study data to identify SFRIs and linked inpatient, outpatient, and ambulatory Medicare data to identify AFRIs. Sensitivity and specificity were assessed, with AFRIs defined using the University of California at Los Angeles/RAND algorithm as the criterion standard. Logistic regression models were used to identify sociodemographic and health predictors of sensitivity.
Overall sensitivity and specificity were 28% and 92%. Sensitivity was greater for the oldest adults (38%), women (34%), those with more functional limitations (47%), and those with a prior fall (38%). In adjusted results, several participant factors (being female, being white, poor functional status, depression, prior falls) were modestly associated with better sensitivity and specificity. Injury severity (requiring hospital care) most substantively improved SFRI sensitivity (73%).
An overwhelming 72% of individuals who received Medicare-reimbursed health care for FRIs failed to report a fall injury when asked. Future efforts to address underreporting in primary care of nonwhite and healthier older adults are critical to improve preventive efforts. Redesigned questions-for example, that address stigma of attributing injury to falling-may improve sensitivity.
比较自我报告的与跌倒相关的伤害（SFRIs）与行政获得的跌倒相关伤害（AFRIs）的准确性及其影响因素。
回顾性观察研究
美国
65 岁及以上的付费医疗保险受益人（N=47215）。
我们使用了 2000-2012 年健康与退休研究数据的 24 个月自我报告回忆数据来识别 SFRIs，并将住院、门诊和门诊 Medicare 数据进行关联以识别 AFRIs。评估了敏感性和特异性，使用加利福尼亚大学洛杉矶分校/兰德算法（UCLA/RAND）作为标准来定义 AFRIs。使用逻辑回归模型来确定影响敏感性的社会人口统计学和健康预测因素。
总体敏感性和特异性分别为 28%和 92%。最年长的成年人（38%）、女性（34%）、功能障碍较多的成年人（47%）和有过跌倒史的成年人（38%）的敏感性更高。在调整后的结果中，一些参与者因素（女性、白人、功能状态较差、抑郁、既往跌倒）与敏感性和特异性略有相关。伤害严重程度（需要住院治疗）显著提高了 SFRI 的敏感性（73%）。
在接受 Medicare 报销的跌倒相关伤害医疗保健的人群中，超过 72%的人在被问及是否发生跌倒伤害时没有报告。未来在初级保健中解决非白人及更健康的老年人漏报问题至关重要，这有助于改进预防措施。重新设计的问题（例如，解决将伤害归因于跌倒的耻辱感问题）可能会提高敏感性。
