German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
Int Wound J. 2022 Jan;19(1):76-85. doi: 10.1111/iwj.13599. Epub 2021 May 5.
Patients with chronic leg ulcer, pressure ulcer, or diabetic foot ulcer suffer from significant disease burden. With a view to improving healthcare provision sustainably, a predictive model of time to closure (time-to-event analysis) based on claims data was developed. To identify potential predictors of wound closure, clinical information absent from statutory health insurance (SHI) data was modelled. In patients with leg ulcers, age of the patient (hazard ratios [HR] 0.99), increasing number of comorbidities (HR 0.94), inpatient stays (HR 0.74), and treatment by a specialised wound care professional (HR 1.18) were significant predictors of time to closure (adjusted model). In almost all models, the number of inpatient stays and of comorbidities predicted a lower probability of healing. In addition, the age and the sex of the patient were found to be significant predictors in some models (leg ulcer: HR 0.99; pressure ulcer: HR 0.99). Increasing number of comorbidities and inpatient stays were predictors for closure time in all models. Since these predictors may give an indication of wound severity, further clinical information should be considered in future models, as also indicated by the moderate values of the c-statistics. This requires future data linkage between SHI and primary studies (eg, registers).
患有慢性腿部溃疡、压疮或糖尿病足溃疡的患者承受着巨大的疾病负担。为了可持续地改善医疗服务，基于索赔数据开发了一种用于预测愈合时间（时间事件分析）的模型。为了确定伤口愈合的潜在预测因素，对法定健康保险 (SHI) 数据中不存在的临床信息进行建模。在腿部溃疡患者中，患者年龄（风险比 [HR] 0.99）、合并症数量增加（HR 0.94）、住院治疗（HR 0.74）和接受专业伤口护理专业人员治疗（HR 1.18）是愈合时间的显著预测因素（调整模型）。在几乎所有模型中，住院次数和合并症数量都预示着愈合的可能性降低。此外，患者的年龄和性别在某些模型中被发现是显著的预测因素（腿部溃疡：HR 0.99；压疮：HR 0.99）。合并症和住院次数的增加是所有模型中愈合时间的预测因素。由于这些预测因素可能表明伤口的严重程度，因此未来的模型中应考虑进一步的临床信息，这也反映在 C 统计量的中等值上。这需要在 SHI 和初级研究（例如，登记处）之间进行未来的数据链接。
