García-Arango Víctor, Osorio-Ciro Jorge, Aguirre-Acevedo Daniel, Vanegas-Vargas Catalina, Clavijo-Usuga Carmen, Gallo-Villegas Jaime
Universidad de Antioquia Medellín Colombia Universidad de Antioquia, Medellín, Colombia.
Institución Prestadora de Servicios de Salud Universitaria Medellín Colombia Institución Prestadora de Servicios de Salud Universitaria, Medellín, Colombia.
Rev Panam Salud Publica. 2021 Feb 26;45:e15. doi: 10.26633/RPSP.2021.15. eCollection 2021.
Evaluate the predictive validity of a functional classification (FC) method for the use of emergency services and hospitalization, mortality, and health care costs among older adults.
Retrospective cohort study that included 2 168 older adults in a chronic noncommunicable disease (CNCD) care program in Medellin, Colombia. Patients were stratified according to a FC method based on functional status, presence of risk factors, and control of comorbidity. During one year of follow-up, the predictive validity of the FC method was assessed for the studied outcomes. Discrimination and calibration were measured with the C-statistic and Hosmer-Lemeshow (HL) test, respectively.
The average age was 74.6 ± 7.9 years; 40.8% (n = 884) were men and 7.7% (n = 168) died. The risk of death (odds ratio [OR]: 1.767; 3.411; 8.525), hospitalization (OR: 1.397; 2.172; 3.540) and high cost of health care (OR: 1.703; 2.369; 5.073) increased in proportion to a deterioration in functional classification (classes 2B, 3, and 4, respectively). The predictive model for the outcome of death showed good capacity for discrimination (C-statistic = 0.721) and calibration (HL statistic 10.200; = 0.251).
There is a dose-response relationship between deterioration in FC and a higher risk of death, hospitalization, and high cost. FC has predictive validity for the mortality rate and could be used to stratify older adults in CNCD care programs with a view to guiding interventions.
评估一种功能分类（FC）方法对老年人使用急诊服务和住院治疗、死亡率及医疗保健费用的预测效度。
进行回顾性队列研究，纳入了哥伦比亚麦德林市一个慢性非传染性疾病（CNCD）护理项目中的2168名老年人。根据基于功能状态、危险因素的存在情况及合并症控制情况的FC方法对患者进行分层。在一年的随访期间，评估FC方法对所研究结局的预测效度。分别用C统计量和Hosmer-Lemeshow（HL）检验来衡量区分度和校准度。
平均年龄为74.6±7.9岁；40.8%（n = 884）为男性，7.7%（n = 168）死亡。死亡风险（比值比[OR]：1.767；3.411；8.525）、住院风险（OR：1.397；2.172；3.540）和高医疗保健费用风险（OR：1.703；2.369；5.073）随着功能分类的恶化（分别为2B、3和4级）而按比例增加。死亡结局的预测模型显示出良好的区分能力（C统计量 = 0.721）和校准度（HL统计量10.200；P = 0.251）。
FC的恶化与更高的死亡、住院和高费用风险之间存在剂量反应关系。FC对死亡率具有预测效度，可用于对CNCD护理项目中的老年人进行分层，以指导干预措施。
