Sinn Chi-Ling Joanna, Heckman George, Poss Jeffrey W, Onder Graziano, Vetrano Davide Liborio, Hirdes John
School of Public Health and Health Systems (Sinn, Heckman, Poss, Hirdes), University of Waterloo; Research Institute for Aging (Heckman), Waterloo, Ont.; Department of Cardiovascular, Metabolic and Aging Diseases (Onder), Istituto Superiore di Sanità, Rome, Italy; Fondazione Policlinico Universitario Agostino Gemelli IRCCS (Vetrano), Università Cattolica del Sacro Cuore, Rome, Italy; Aging Research Center (Vetrano), Department of Neurobiology Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
School of Public Health and Health Systems (Sinn, Heckman, Poss, Hirdes), University of Waterloo; Research Institute for Aging (Heckman), Waterloo, Ont.; Department of Cardiovascular, Metabolic and Aging Diseases (Onder), Istituto Superiore di Sanità, Rome, Italy; Fondazione Policlinico Universitario Agostino Gemelli IRCCS (Vetrano), Università Cattolica del Sacro Cuore, Rome, Italy; Aging Research Center (Vetrano), Department of Neurobiology Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
CMAJ Open. 2020 Dec 1;8(4):E796-E809. doi: 10.9778/cmajo.20200083. Print 2020 Oct-Dec.
In Ontario, Canada, nearly all home care patients are assessed with a brief clinical assessment (interRAI Contact Assessment [interRAI CA]) on admission. Our objective was to compare 3 frailty measures that can be operationalized using the interRAI CA.
We conducted a retrospective cohort study using linked patient-level assessment and administrative data for all Ontario adult (≥ 18 yr) home care patients assessed with the interRAI CA in 2014. We employed multivariable logistic models to compare the Changes in Health, End-stage disease and Signs and Symptoms Scale for the Contact Assessment (CHESS-CA), Assessment Urgency Algorithm (AUA) and the Frailty Index for the Contact Assessment (FI-CA) that was created for this study. Our outcomes of interest were death, hospital admission and emergency department visits within 90 days, and assessor-rated need for comprehensive geriatric assessment (CGA).
In 2014, there were 228 679 unique adult home care patients in Ontario assessed with the interRAI CA. Controlling for age, sex and health region, being in a higher frailty level defined by any measure increased the likelihood of experiencing adverse outcomes. Among all assessments, CHESS-CA was best suited for predicting death and hospital admission, and either AUA or FI-CA for predicting perceived need for CGA. Previous emergency department visits were more predictive of future visits than frailty. Model fit was independent of whether the assessment was completed over the phone or in person.
Frailty measures from the interRAI CA identified patients at higher risk for death, hospital admission and perceived need for CGA. In jurisdictions where the CHESS-CA and AUA are already built into the electronic home care platform, such as Ontario, patients identified as high risk should be prioritized for proactive referral and care planning, and may benefit from greater involvement of primary care and other health professionals in the circle of care.
在加拿大安大略省，几乎所有家庭护理患者入院时都要接受简短临床评估（相互关系入院接触评估[interRAI CA]）。我们的目的是比较3种可通过interRAI CA实施的衰弱测量方法。
我们进行了一项回顾性队列研究，使用了2014年接受interRAI CA评估的安大略省所有成年（≥18岁）家庭护理患者的患者层面评估数据与行政数据的关联。我们采用多变量逻辑模型来比较接触评估的健康变化、终末期疾病及体征和症状量表（CHESS-CA）、评估紧急算法（AUA）以及为本研究创建的接触评估衰弱指数（FI-CA）。我们感兴趣的结局是90天内的死亡、住院和急诊就诊，以及评估者评定的综合老年评估（CGA）需求。
2014年，安大略省有228679名接受interRAI CA评估的成年家庭护理患者。在控制年龄、性别和健康区域后，任何一种测量方法定义的更高衰弱水平都会增加出现不良结局的可能性。在所有评估中，CHESS-CA最适合预测死亡和住院，而AUA或FI-CA最适合预测CGA的感知需求。既往急诊就诊比衰弱更能预测未来就诊。模型拟合与评估是通过电话还是亲自完成无关。
interRAI CA的衰弱测量方法识别出了死亡、住院及CGA感知需求风险较高的患者。在像安大略省这样电子家庭护理平台已内置CHESS-CA和AUA的司法管辖区，被确定为高风险的患者应优先进行主动转诊和护理规划，并且可能会从初级保健和其他卫生专业人员更多地参与护理环节中受益。
