Meyer Anna Maria, Siri Giacomo, Becker Ingrid, Betz Thomas, Bödecker August W, Robertz Jörg W, Krause Olaf, Benzing Thomas, Pilotto Alberto, Polidori Maria Cristina
Ageing Clinical Research, Department II of Internal Medicine and Center for Molecular Medicine Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
Scientific Directorate-Biostatistics, E.O. Galliera Hospital, Genova, Italy.
Int J Clin Pract. 2019 Aug 13:e13403. doi: 10.1111/ijcp.13403.
Older patients' health problems in general practice (GP) can often not be assigned to a specific disease, requiring a paradigm shift to goal-oriented, personalised care for clinical decision making.
To investigate the predictive value of the comprehensive geriatric assessment (CGA)-based Multidimensional Prognostic Index (MPI) in a GP setting with respect to the main healthcare indicators during the 12 months following initial evaluation.
One hundred twenty-five consecutive patients aged 70 years and older were enrolled in a GP and followed up to one year. All patients underwent a CGA based on which the MPI was calculated and subdivided into three risk groups (MPI-1, 0-0.33 = low risk, MPI-2, 0.34-0.66 = moderate risk and MPI-3, 0.67-1, severe risk). Grade of Care (GC), hospitalization rate, mortality, nursing home admission, use of home care services, falls, number of general practitioner contacts (GPC), of geriatric resources (GR) and geriatric syndromes (GS) during the 12 months following initial evaluation were collected.
The MPI was significantly associated with number of GS (P < .001), GR (P < .001), GC (P < .001) as well as with the average number of GPC per year (mean 10.4, P = .046). Interestingly, the clinical judgement of the general practitioner, in this case knowing his patients for 16 years on average, was associated with adverse outcomes to a similar extent than the prediction offered by the MPI (GP/adverse outcomes and MPI/adverse outcomes P < .001).
The MPI is strongly associated with adverse outcomes in older GP patients and strongly predicts the number of GPC up to one year after initial evaluation. Considering the feasibility and the strong clinimetric properties of the MPI, its collection should be encouraged as early as possible to disclose risk conditions, implement tailored preventive strategies and improve cost-effectiveness of healthcare resources use.
在全科医疗中，老年患者的健康问题往往无法归因于某一特定疾病，这就需要转变模式，采用以目标为导向的个性化护理进行临床决策。
在全科医疗环境中，研究基于综合老年评估（CGA）的多维预后指数（MPI）对初次评估后12个月内主要医疗指标的预测价值。
连续纳入125例70岁及以上的患者，在全科医疗中进行为期一年的随访。所有患者均接受了CGA，并据此计算MPI，将其分为三个风险组（MPI-1，0-0.33 =低风险；MPI-2，0.34-0.66 =中度风险；MPI-3，0.67-1，高风险）。收集初次评估后12个月内的护理等级（GC）、住院率、死亡率、养老院入住率、家庭护理服务使用情况、跌倒次数、全科医生接触次数（GPC）、老年资源（GR）和老年综合征（GS）数量。
MPI与GS数量（P <.001）、GR数量（P <.001）、GC（P <.001）以及每年GPC的平均次数显著相关（平均10.4次，P =.046）。有趣的是，全科医生的临床判断（在本研究中，全科医生平均认识其患者16年）与不良结局之间的关联程度与MPI提供的预测相似（全科医生/不良结局与MPI/不良结局，P <.001）。
MPI与老年全科医疗患者的不良结局密切相关，并能强烈预测初次评估后长达一年的GPC次数。考虑到MPI的可行性和强大的临床测量特性，应尽早鼓励收集MPI，以揭示风险状况，实施针对性的预防策略，并提高医疗资源使用的成本效益。
