Clark D O, Von Korff M, Saunders K, Baluch W M, Simon G E
Indiana University Department of Medicine, Indianapolis, USA.
Med Care. 1995 Aug;33(8):783-95. doi: 10.1097/00005650-199508000-00004.
Different types of medication prescribed during a 6-month period for the treatment and management of chronic conditions were utilized in the refinement and validation of a chronic disease score. Prescription data, in addition to age and sex, were utilized to develop a chronic disease score based on empirically derived weights for each of three outcomes: total cost, outpatient cost, and primary care visits. The ability of the revised chronic disease score to predict health care utilization, costs, hospitalization, and mortality was compared to an earlier version of the chronic disease score (original) that was derived through clinical judgments of disease severity. The predictive validity of the chronic disease score is also compared to ambulatory care groups, which utilize outpatient diagnoses to form mutually exclusive diagnostic categories. Models based on a concurrent 6-month period and a 6-month prospective period (ie, the 6-month period after the chronic disease score or ambulatory care group derivation period) were estimated using a random one half sample of 250,000 managed-care enrollees aged 18 and older. The remaining one half of the enrollee population was used as a validation sample. The revised chronic disease score showed improved estimation and prediction over the original chronic disease score. The difference in variance explained prospectively by the revised chronic disease score versus the ambulatory care groups, conversely, was small. The revised chronic disease score was a better predictor of mortality than the ambulatory care groups. The combination of revised chronic disease score and ambulatory care groups showed only marginally greater predictive power than either one alone. These results suggest that the revised chronic disease score and ambulatory care groups with empirically derived weights provide improved prediction of health care utilization and costs, as well as hospitalization and mortality, over age and sex alone. We recommend the revised chronic disease score with total cost weights for general use as a severity measure because of its relative advantage in predicting mortality compared to the outpatient cost and primary care visit weights.
在6个月期间为治疗和管理慢性病而开具的不同类型药物被用于完善和验证慢性病评分。除年龄和性别外，处方数据还被用于基于三种结果（总成本、门诊成本和初级保健就诊次数）的经验性权重来制定慢性病评分。将修订后的慢性病评分预测医疗保健利用、成本、住院率和死亡率的能力与通过疾病严重程度的临床判断得出的早期版本慢性病评分（原始版本）进行比较。慢性病评分的预测效度也与门诊护理组进行比较，门诊护理组利用门诊诊断形成相互排斥的诊断类别。使用250,000名年龄在18岁及以上的管理式医疗参保者的随机一半样本，估计基于同期6个月和6个月前瞻性时期（即慢性病评分或门诊护理组推导期后的6个月时期）的模型。参保人群的另一半用作验证样本。修订后的慢性病评分在估计和预测方面比原始慢性病评分有所改善。相反，修订后的慢性病评分与门诊护理组在预测方面的方差差异很小。修订后的慢性病评分在预测死亡率方面比门诊护理组更好。修订后的慢性病评分和门诊护理组的组合仅比单独任何一个略具更大的预测能力。这些结果表明，与仅考虑年龄和性别相比，具有经验性权重的修订后的慢性病评分和门诊护理组在预测医疗保健利用、成本以及住院率和死亡率方面有所改善。由于与门诊成本和初级保健就诊权重相比，其在预测死亡率方面具有相对优势，我们建议将具有总成本权重的修订后的慢性病评分作为严重程度衡量指标普遍使用。
