Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.
Department of Geriatric Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan.
BMC Geriatr. 2020 Sep 9;20(1):335. doi: 10.1186/s12877-020-01734-1.
Clinical guidelines for specific conditions fragment care provision for elders. The International Consortium for Health Outcomes Measurement (ICHOM) has developed a global standard set of outcome measures for comprehensive assessment of older persons. The goal of this study was to report value-based health metrics in Taiwan using this ICHOM toolset.
The cross-sectional study of baseline data excerpted from a prospective longitudinal cohort, which recruited people ≥65 years old with ≥3 chronic medical conditions between July and December 2018. All participants received measurements of physical performance, anthropometric characteristics, health-related behaviors, Charlson Comorbidity Index, and Montreal Cognitive Assessment. The ICHOM toolset comprises three tiers: 1 includes frailty and having chosen a preferred place of death; 2 includes polypharmacy, falls, and participation in decision-making; and 3 includes loneliness, activities of daily living, pain, depression, and walking speed. These items were converted into a 0-10 point value-based healthcare score, with high value-based health status defined as ≥8/10 points.
Frequencies of individual ICHOM indicators were: frail 11.7%, chose preferred place of death 14.4%, polypharmacy 31.5%, fell 17.1%, participated in decision-making 81.6%, loneliness 26.8%, limited activities of daily living 22.4%, pain 10.4%, depressed mood 13.0%, and slowness 38.5%. People with high disease burden (OR 0.40, 95% CI 0.21-0.76, p = 0.005) or cognitive impairment (OR 0.49, 95%CI 0.27-0.87, p = 0.014) were less likely to have high value-based healthcare status.
The ICHOM Standard Set Older Person health outcome measures provide an opportunity to shift from a disease-centric medical paradigm to whole person-focused goals. This study identified advanced age, chronic disease burden and cognitive impairment as important barriers to achieving high value-based healthcare status.
针对特定病症的临床指南割裂了老年人的医疗服务。国际健康结果测量协会（ICHOM）已制定了一套全球通用的老年人综合评估结果衡量标准。本研究旨在使用该 ICHOM 工具包报告台湾基于价值的健康指标。
本研究为一项横断面研究，数据源自一项前瞻性纵向队列研究，该研究于 2018 年 7 月至 12 月期间招募了≥65 岁且患有≥3 种慢性疾病的人群。所有参与者均接受了身体表现、人体测量特征、健康相关行为、Charlson 合并症指数和蒙特利尔认知评估的测量。ICHOM 工具包包括三个层级：1 级包括虚弱和选择理想的死亡地点；2 级包括多重用药、跌倒和参与决策；3 级包括孤独、日常生活活动、疼痛、抑郁和行走速度。这些项目被转化为 0-10 分的基于价值的医疗保健评分，高基于价值的健康状况定义为≥8/10 分。
ICHOM 指标的个体频率分别为：虚弱 11.7%、选择理想的死亡地点 14.4%、多重用药 31.5%、跌倒 17.1%、参与决策 81.6%、孤独 26.8%、日常生活活动受限 22.4%、疼痛 10.4%、抑郁情绪 13.0%和行走缓慢 38.5%。疾病负担高（OR 0.40，95%CI 0.21-0.76，p=0.005）或认知障碍（OR 0.49，95%CI 0.27-0.87，p=0.014）的患者不太可能具有高基于价值的医疗保健状态。
ICHOM 标准集老年人健康结果衡量标准提供了从以疾病为中心的医疗模式转变为以整个人为中心的目标的机会。本研究确定了高龄、慢性疾病负担和认知障碍是实现高基于价值的医疗保健状态的重要障碍。
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