Anesthesiology and Pain Medicine, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
BMJ Qual Saf. 2023 Sep;32(9):546-556. doi: 10.1136/bmjqs-2021-013150. Epub 2021 Jul 30.
Days alive and at home (DAH) is a patient centered outcome measureable in routinely collected health data. The validity and minimally important difference (MID) in hip fracture have not been evaluated.
We assessed construct and predictive validity and estimated a MID for the patient-centred outcome of DAH after hip fracture admission.
This is a cross-sectional observational study using linked health administrative data in Ontario, Canada. DAH was calculated as the number of days alive within 90 days of admission minus the number of days hospitalised or institutionalised. All hospital admissions (2012-2018) for hip fracture in adults aged >50 years were included. Construct validity analyses used Bayesian quantile regression to estimate the associations of postulated patient, admission and process-related variables with DAH. The predictive validity assessed was the correlation of DAH in 90 days with the value from 91 to 365 days; and the association and discrimination of DAH in 90 days predicting subsequent mortality. MID was estimated by averaging distribution-based and clinical anchor-based estimates.
We identified 63 778 patients with hip fracture. The median number of DAH was 43 (range 0-87). In the 90 days after admission, 8050 (12.6%) people died; a further 6366 (10.0%) died from days 91 to 365. Associations between patient-level and admission-level factors with the median DAH (lower with greater age, frailty and comorbidity, lower if admitted to intensive care or having had a complication) supported construct validity. DAH in 90 days after admission was strongly correlated with DAH in 365 days after admission (r=0.922). An 11-day MID was estimated.
DAH has face, construct and predictive validity as a patient-centred outcome in patients with hip fracture, with an estimated MID of 11 days. Future research is required to include direct patient perspectives in confirming MID.
存活且在家的天数（DAH）是一种可从常规收集的健康数据中测量的以患者为中心的结局指标。其在髋部骨折中的效度和最小临床重要差异（MID）尚未得到评估。
我们评估了髋部骨折入院后 DAH 这一以患者为中心的结局指标的构建效度、预测效度，并估计了其 MID。
这是一项使用加拿大安大略省链接健康管理数据的横断面观察性研究。DAH 的计算方法为入院后 90 天内存活天数减去住院或机构化天数。纳入所有年龄>50 岁成人的髋部骨折（2012-2018 年）的所有住院治疗。构建效度分析使用贝叶斯分位数回归来估计假设的患者、入院和过程相关变量与 DAH 的关联。预测效度评估为 90 天内的 DAH 值与 91 至 365 天内的 DAH 值之间的相关性；以及 90 天内的 DAH 值与随后死亡率之间的关联和区分度。MID 通过平均基于分布的和基于临床锚定的估计来估计。
我们共确定了 63778 例髋部骨折患者。DAH 的中位数为 43 天（范围 0-87 天）。在入院后 90 天内，有 8050 人（12.6%）死亡；另外有 6366 人（10.0%）在 91 至 365 天内死亡。患者层面和入院层面的因素与中位数 DAH（年龄较大、虚弱和合并症程度较高、入住重症监护病房或发生并发症时 DAH 较低）之间的关联支持了构建效度。入院后 90 天内的 DAH 与入院后 365 天内的 DAH 呈高度相关（r=0.922）。估计的 MID 为 11 天。
DAH 是髋部骨折患者以患者为中心的结局指标，具有良好的表面效度、构建效度和预测效度，其 MID 估计值为 11 天。未来的研究需要包括直接的患者视角来确认 MID。
