定义老年患者因医疗状况住院时的多重疾病。
Defining Multimorbidity in Older Patients Hospitalized with Medical Conditions.
机构信息
Center for Outcomes Research, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA, USA.
出版信息
J Gen Intern Med. 2023 May;38(6):1449-1458. doi: 10.1007/s11606-022-07897-4. Epub 2022 Nov 16.
BACKGROUND
The term "multimorbidity" identifies high-risk, complex patients and is conventionally defined as ≥2 comorbidities. However, this labels almost all older patients as multimorbid, making this definition less useful for physicians, hospitals, and policymakers.
OBJECTIVE
Develop new medical condition-specific multimorbidity definitions for patients admitted with acute myocardial infarction (AMI), heart failure (HF), and pneumonia patients. We developed three medical condition-specific multimorbidity definitions as the presence of single, double, or triple combinations of comorbidities - called Qualifying Comorbidity Sets (QCSs) - associated with at least doubling the risk of 30-day mortality for AMI and pneumonia, or one-and-a-half times for HF patients, compared to typical patients with these conditions.
DESIGN
Cohort-based matching study PARTICIPANTS: One hundred percent Medicare Fee-for-Service beneficiaries with inpatient admissions between 2016 and 2019 for AMI, HF, and pneumonia.
MAIN MEASURES
Thirty-day all-location mortality KEY RESULTS: We defined multimorbidity as the presence of ≥1 QCS. The new definitions labeled fewer patients as multimorbid with a much higher risk of death compared to the conventional definition (≥2 comorbidities). The proportions of patients labeled as multimorbid using the new definition versus the conventional definition were: for AMI 47% versus 87% (p value<0.0001), HF 53% versus 98% (p value<0.0001), and pneumonia 57% versus 91% (p value<0.0001). Thirty-day mortality was higher among patients with ≥1 QCS compared to ≥2 comorbidities: for AMI 15.0% versus 9.5% (p<0.0001), HF 9.9% versus 7.0% (p <0.0001), and pneumonia 18.4% versus 13.2% (p <0.0001).
CONCLUSION
The presence of ≥2 comorbidities identified almost all patients as multimorbid. In contrast, our new QCS-based definitions selected more specific combinations of comorbidities associated with substantial excess risk in older patients admitted for AMI, HF, and pneumonia. Thus, our new definitions offer a better approach to identifying multimorbid patients, allowing physicians, hospitals, and policymakers to more effectively use such information to consider focused interventions for these vulnerable patients.
背景
“多病共存”一词用于识别高风险、复杂的患者，通常定义为≥2 种合并症。然而，这几乎将所有老年人都定义为多病共存，这使得该定义对医生、医院和决策者的用处不大。
目的
为因急性心肌梗死（AMI）、心力衰竭（HF）和肺炎入院的患者制定新的特定于医疗状况的多病共存定义。我们为 AMI 和肺炎患者制定了三种特定于医疗状况的多病共存定义，将与 AMI 和肺炎患者 30 天全因死亡率增加一倍，或 HF 患者增加 1.5 倍相关的单一、双重或三重合并症组合（称为合格合并症集，QCS）定义为多病共存；与这些病症的典型患者相比。
设计
基于队列的匹配研究
参与者
2016 年至 2019 年期间，100%的 Medicare 按服务收费患者因 AMI、HF 和肺炎住院。
主要措施
30 天全因死亡率
主要结果
我们将多病共存定义为存在≥1 个 QCS。与传统定义（≥2 种合并症）相比，新定义将更少的患者标记为多病共存，且死亡率风险更高。使用新定义与传统定义将患者标记为多病共存的比例为：AMI 为 47%比 87%（p 值<0.0001），HF 为 53%比 98%（p 值<0.0001），肺炎为 57%比 91%（p 值<0.0001）。与≥2 种合并症相比，患有≥1 个 QCS 的患者 30 天死亡率更高：AMI 为 15.0%比 9.5%（p<0.0001），HF 为 9.9%比 7.0%（p <0.0001），肺炎为 18.4%比 13.2%（p <0.0001）。
结论
存在≥2 种合并症几乎将所有患者都定义为多病共存。相比之下，我们新的基于 QCS 的定义选择了与 AMI、HF 和肺炎入院的老年患者风险显著增加相关的更具体的合并症组合。因此，我们新的定义提供了一种更好的方法来识别多病共存患者，使医生、医院和决策者能够更有效地利用这些信息，为这些脆弱患者考虑有针对性的干预措施。
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