Am J Epidemiol. 2023 Nov 10;192(12):2085-2093. doi: 10.1093/aje/kwad151.
The Faurot frailty index (FFI) is a validated algorithm that uses enrollment and International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM)-based billing information from Medicare claims data as a proxy for frailty. In October 2015, the US health-care system transitioned from the ICD-9-CM to the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM). Applying the Centers for Medicare and Medicaid Services General Equivalence Mappings, we translated diagnosis-based frailty indicator codes from the ICD-9-CM to the ICD-10-CM, followed by manual review. We used interrupted time-series analysis of Medicare data to assess the comparability of the pre- and posttransition FFI scores. In cohorts of beneficiaries enrolled in January 2015-2017 with 8-month frailty look-back periods, we estimated associations between the FFI and 1-year risk of aging-related outcomes (mortality, hospitalization, and admission to a skilled nursing facility). Updated indicators had similar prevalences as pretransition definitions. The median FFI scores and interquartile ranges (IQRs) for the predicted probability of frailty were similar before and after the International Classification of Diseases transition (pretransition: median, 0.034 (IQR, 0.02-0.07); posttransition: median, 0.038 (IQR, 0.02-0.09)). The updated FFI was associated with increased risks of mortality, hospitalization, and skilled nursing facility admission, similar to findings from the ICD-9-CM era. Studies of medical interventions in older adults using administrative claims should use validated indices, like the FFI, to mitigate confounding or assess effect-measure modification by frailty.
Faurot 衰弱指数(FFI)是一种经过验证的算法,它使用医疗保险索赔数据中的登记和国际疾病分类,第九修订版,临床修正(ICD-9-CM)为基础的计费信息作为衰弱的代表。2015 年 10 月,美国医疗保健系统从 ICD-9-CM 过渡到国际疾病分类,第十版,临床修正(ICD-10-CM)。应用医疗保险和医疗补助服务中心通用等价映射,我们将基于诊断的衰弱指标代码从 ICD-9-CM 转换为 ICD-10-CM,然后进行手动审查。我们使用医疗保险数据的中断时间序列分析来评估转换前后 FFI 评分的可比性。在 2015 年 1 月至 2017 年登记的受益人群中,有 8 个月的衰弱回溯期,我们估计了 FFI 与 1 年与衰老相关的结果(死亡率、住院和入住熟练护理设施)之间的关联。更新后的指标与转换前的定义具有相似的患病率。在 ICD 转换前后(转换前:中位数,0.034(IQR,0.02-0.07);转换后:中位数,0.038(IQR,0.02-0.09)),预测衰弱概率的 FFI 中位数和四分位距(IQR)相似。更新后的 FFI 与死亡率、住院和熟练护理设施入院的风险增加相关,与 ICD-9-CM 时代的研究结果相似。使用行政索赔对老年人进行医疗干预的研究应使用经过验证的指数,如 FFI,以减轻混杂或评估衰弱对效应量修正的影响。
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