Orlando Edelen Maria, Rodriguez Anthony, Qureshi Nabeel, Herman Patricia M, Hays Ron D
RAND Corporation, Behavioral and Policy Sciences, 20 Park Plaza #920, Boston, MA.
Patient Reported Outcomes, Value and Experience (PROVE) Center, Department of Surgery, Brigham and Women's Hospital, Boston, MA.
J Geriatr Med Gerontol. 2023;9(1). doi: 10.23937/2469-5858/1510141. Epub 2023 Jan 23.
To evaluate the utility of the Impact Stratification Score (ISS) in characterizing health-related disease burden for older adult patients with multiple chronic conditions (MCC).
The sample of 1226 older adult MCC patients (average age of 80, 51% female, and 89% White) completed the PROMIS-29 v2.1 profile that contains the 9 ISS items. The ISS was examined using factor analysis (i.e., correlated factors and bifactor models). We evaluated the relative validity of ISS compared with other PROMIS-29 scores using ratio of F-statistics from multivariate regressions predicting each PROMIS-29 score from patient chronic conditions and utilization patterns.
Bifactor model results indicated essential unidimensionality, primarily reflecting one general construct (i.e., impact) and that, after accounting for impact, very little reliable variance remained in the two group factors. General impact scores were reliable (omegaH =.73). ISS scores were significantly higher according to older age, female gender, and Hispanic ethnicity, increased with increasing number of chronic conditions, and were strongly related to presence of most chronic conditions and healthcare utilization rates. Relative efficiency coefficients revealed that ISS scores were more strongly related to most chronic conditions relative to PROMIS pain intensity, physical health, and pain interference scores and outperformed the PROMIS-29 physical health summary score for several conditions including arthritis, diabetes, and high blood pressure.
This study presents evidence that the ISS is a sufficiently unidimensional and reliable measure that may be useful in characterizing health-related disease burden among older adult ambulatory patients with two or more chronic conditions.
评估影响分层评分（ISS）在表征患有多种慢性病（MCC）的老年患者健康相关疾病负担方面的效用。
1226名老年MCC患者样本（平均年龄80岁，51%为女性，89%为白人）完成了包含9个ISS项目的PROMIS - 29 v2.1量表。使用因子分析（即相关因子和双因子模型）对ISS进行检验。我们通过多元回归预测每个PROMIS - 29评分的F统计量比值，评估ISS与其他PROMIS - 29评分相比的相对效度，多元回归是根据患者慢性病情况和使用模式来预测每个PROMIS - 29评分。
双因子模型结果表明基本为单维性，主要反映一个总体结构（即影响），并且在考虑影响因素后，两组因子中几乎没有可靠的方差剩余。总体影响评分是可靠的（ωH = 0.73）。根据年龄较大、女性和西班牙裔种族，ISS评分显著更高，随着慢性病数量增加而升高，并且与大多数慢性病的存在以及医疗保健利用率密切相关。相对效率系数显示，相对于PROMIS疼痛强度、身体健康和疼痛干扰评分，ISS评分与大多数慢性病的相关性更强，并且在包括关节炎、糖尿病和高血压等几种疾病中，其表现优于PROMIS - 29身体健康总结评分。
本研究提供的证据表明，ISS是一种足够单维且可靠的测量方法，可能有助于表征患有两种或更多慢性病的老年门诊患者的健康相关疾病负担。
