Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands,
Department of Old-Age Medicine Hubertusduin, HMC Bronovo, The Hague, the Netherlands.
Clin Interv Aging. 2019 Feb 11;14:289-299. doi: 10.2147/CIA.S185112. eCollection 2019.
To investigate the reliability of a weighted version of the Functional Comorbidity Index (w-FCI) compared with that of the original Functional Comorbidity Index (FCI) and to test its usability.
Sixteen physicians collected data from 102 residents who lived in 16 different nursing homes in the Netherlands. A multicenter, prospective observational study was carried out in combination with a qualitative part using the three-step test interview, in which participants completed the w-FCI while thinking aloud and being observed, and were then interviewed afterward. To analyze inter-rater reliability, a subset of 41 residents participated. The qualitative part of the study was completed by eleven elderly care physicians and one advanced nurse practitioner.
The w-FCI was composed of the original FCI supplemented with a severity rating per comorbidity, ranging from 0 (disease absent) to 3 (severe impact on daily function). The w-FCI was filled out at baseline by 16 physicians and again 2 months later to establish intra-rater reliability (intraclass correlations; ICCs). For inter-rater reliability, four pairs of raters completed the w-FCI independently from each other.
The ICCs were 0.90 (FCI) and 0.94 (w-FCI) for intra-rater reliability, and 0.61 (FCI) and 0.55 (w-FCI) for inter-rater reliability. Regarding usability of the w-FCI, five meaningful themes emerged from the qualitative data: 1) sources of information; 2) deciding on the presence or absence of disease; 3) severity of comorbidities; 4) usefulness; and 5) content.
The intra-rater reliability of the FCI and the w-FCI was excellent, whereas the inter-rater reliability was moderate for both indices. Based on the present results, a modified w-FCI is proposed that is acceptable and feasible for use in older patients and requires further investigation to study its (predictive) validity.
研究加权版功能共病指数（w-FCI）的可靠性，并与原始功能共病指数（FCI）进行比较，同时检验其可用性。
16 名医生从居住在荷兰 16 家不同养老院的 102 名居民那里收集数据。采用多中心前瞻性观察研究，并结合三步测试访谈进行定性部分，参与者在思考和观察的同时填写 w-FCI，然后进行访谈。为了分析组内信度，有 41 名居民参加了一个子样本。该研究的定性部分由 11 名老年护理医生和 1 名高级执业护师完成。
w-FCI 由原始 FCI 补充组成，每个共病都有严重程度评分，范围从 0（无疾病）到 3（严重影响日常生活功能）。16 名医生在基线时填写 w-FCI，2 个月后再次填写以建立组内信度（组内相关系数；ICC）。对于组间信度，4 对评分者相互独立地完成 w-FCI。
组内信度的 ICC 分别为 0.90（FCI）和 0.94（w-FCI），组间信度的 ICC 分别为 0.61（FCI）和 0.55（w-FCI）。关于 w-FCI 的可用性，从定性数据中出现了五个有意义的主题：1）信息来源；2）决定疾病的存在与否；3）共病的严重程度；4）有用性；5）内容。
FCI 和 w-FCI 的组内信度都非常好，而这两个指数的组间信度都为中度。基于目前的结果，提出了一个改良的 w-FCI，它在老年患者中是可以接受和可行的，需要进一步研究以研究其（预测）有效性。
