测量多种并存疾病：根据目的和数据源选择合适的工具。
Measuring Multimorbidity: Selecting the Right Instrument for the Purpose and the Data Source.
机构信息
Behavioral Research Program, National Cancer Institute, Bethesda, MD.
Institute for Health Research, Kaiser Permanente Colorado.
出版信息
Med Care. 2021 Aug 1;59(8):743-756. doi: 10.1097/MLR.0000000000001566.
BACKGROUND
Adults have a higher prevalence of multimorbidity-or having multiple chronic health conditions-than having a single condition in isolation. Researchers, health care providers, and health policymakers find it challenging to decide upon the most appropriate assessment tool from the many available multimorbidity measures.
OBJECTIVE
The objective of this study was to describe a broad range of instruments and data sources available to assess multimorbidity and offer guidance about selecting appropriate measures.
DESIGN
Instruments were reviewed and guidance developed during a special expert workshop sponsored by the National Institutes of Health on September 25-26, 2018.
RESULTS
Workshop participants identified 4 common purposes for multimorbidity measurement as well as the advantages and disadvantages of 5 major data sources: medical records/clinical assessments, administrative claims, public health surveys, patient reports, and electronic health records. Participants surveyed 15 instruments and 2 public health data systems and described characteristics of the measures, validity, and other features that inform tool selection. Guidance on instrument selection includes recommendations to match the purpose of multimorbidity measurement to the measurement approach and instrument, review available data sources, and consider contextual and other related constructs to enhance the overall measurement of multimorbidity.
CONCLUSIONS
The accuracy of multimorbidity measurement can be enhanced with appropriate measurement selection, combining data sources and special considerations for fully capturing multimorbidity burden in underrepresented racial/ethnic populations, children, individuals with multiple Adverse Childhood Events and older adults experiencing functional limitations, and other geriatric syndromes. The increased availability of comprehensive electronic health record systems offers new opportunities not available through other data sources.
背景
成年人患有多种慢性病（即同时患有多种慢性健康疾病）的发病率高于单一疾病的发病率。研究人员、医疗保健提供者和卫生政策制定者发现，很难从众多可用的多种慢性病衡量标准中选择最合适的评估工具。
目的
本研究旨在描述可用于评估多种慢性病的广泛工具和数据源，并提供选择合适措施的指导。
设计
在 2018 年 9 月 25 日至 26 日由美国国立卫生研究院主办的一次特别专家研讨会上对工具进行了审查并制定了指导意见。
结果
研讨会参与者确定了多种慢性病测量的 4 个常见目的，以及 5 个主要数据源（医疗记录/临床评估、行政索赔、公共卫生调查、患者报告和电子健康记录）的优缺点。参与者调查了 15 种工具和 2 种公共卫生数据系统，并描述了这些措施的特点、有效性和其他特征，这些信息为工具选择提供了依据。关于工具选择的指导包括建议将多种慢性病测量的目的与测量方法和工具相匹配，审查可用的数据源，并考虑上下文和其他相关结构，以增强对多种慢性病的整体测量。
结论
通过适当的测量选择、结合数据源以及特别考虑代表性不足的种族/族裔人群、儿童、经历多种不良童年经历和功能受限的老年人以及其他老年综合病症的多种慢性病负担，可以提高多种慢性病测量的准确性。综合电子健康记录系统的可用性增加提供了其他数据源无法提供的新机会。
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