在行政索赔数据中测量虚弱程度：美国医疗保险数据中四种基于索赔的虚弱程度衡量标准的比较性能。
Measuring Frailty in Administrative Claims Data: Comparative Performance of Four Claims-Based Frailty Measures in the U.S. Medicare Data.
机构信息
Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts.
出版信息
J Gerontol A Biol Sci Med Sci. 2020 May 22;75(6):1120-1125. doi: 10.1093/gerona/glz224.
BACKGROUND
There has been increasing effort to measure frailty in the U.S. Medicare data. The performance of claims-based frailty measures has not been compared.
METHODS
This cross-sectional study included 3,097 community-dwelling fee-for-service Medicare beneficiaries (mean age 75.6 years) who participated in the 2008 Health and Retirement Study examination. Four claims-based frailty measures developed by Davidoff, Faurot, Segal, and Kim were compared against frailty phenotype, a deficit-accumulation frailty index (FI), and activities of daily living (ADL) dependence using Spearman correlation coefficients and C-statistics.
RESULTS
Claims-based frailty measures were positively associated with frailty phenotype (prevalence in ≤10th vs >90th percentile: 8.0% vs 41.3% for Davidoff; 5.9% vs 53.1% for Faurot; 3.3% vs 48.0% for Segal; 2.9% vs 51.0% for Kim) and FI (mean in ≤10th vs >90th percentile: 0.17 vs 0.33 for Davidoff; 0.13 vs 0.37 for Faurot; 0.12 vs 0.31 for Segal; 0.10 vs 0.37 for Kim). The age and sex-adjusted C-statistics for frailty phenotype for Davidoff, Faurot, Segal, and Kim indices were 0.73, 0.74, 0.73, and 0.78, respectively, and partial correlation coefficients with FI were 0.18, 0.32, 0.26, and 0.55, respectively. The results for ADL dependence were similar (prevalence in ≤10th vs >90th percentile: 3.7% vs 50.5% for Davidoff; 2.3% vs 55.0% for Faurot; 3.0% vs 38.3% for Segal; 2.3% vs 50.8% for Kim). The age and sex-adjusted C-statistics for the indices were 0.79, 0.80, 0.74, and 0.81, respectively.
CONCLUSIONS
The choice of a claims-based frailty measure can influence the identification of older adults with frailty and disability in Medicare data.
背景
美国医疗保险数据中评估衰弱的努力一直在增加。尚未比较基于索赔的衰弱衡量标准的性能。
方法
本横断面研究纳入了 3097 名居住在社区的医疗保险费用服务受益人群（平均年龄 75.6 岁），他们参加了 2008 年健康与退休研究检查。比较了 Davidoff、Faurot、Segal 和 Kim 开发的四种基于索赔的衰弱测量方法与衰弱表型、缺陷累积衰弱指数（FI）和日常生活活动（ADL）依赖的 Spearman 相关系数和 C 统计量。
结果
基于索赔的衰弱测量方法与衰弱表型呈正相关（第 10 个百分位数与第 90 个百分位数的患病率：Davidoff 为 8.0%比 41.3%；Faurot 为 5.9%比 53.1%；Segal 为 3.3%比 48.0%；Kim 为 2.9%比 51.0%）和 FI（第 10 个百分位数与第 90 个百分位数的平均值：Davidoff 为 0.17 比 0.33；Faurot 为 0.13 比 0.37；Segal 为 0.12 比 0.31；Kim 为 0.10 比 0.37）。Davidoff、Faurot、Segal 和 Kim 指数的衰弱表型的年龄和性别调整 C 统计量分别为 0.73、0.74、0.73 和 0.78，与 FI 的偏相关系数分别为 0.18、0.32、0.26 和 0.55。ADL 依赖的结果相似（第 10 个百分位数与第 90 个百分位数的患病率：Davidoff 为 3.7%比 50.5%；Faurot 为 2.3%比 55.0%；Segal 为 3.0%比 38.3%；Kim 为 2.3%比 50.8%）。这些指数的年龄和性别调整 C 统计量分别为 0.79、0.80、0.74 和 0.81。
结论
在 Medicare 数据中，基于索赔的衰弱衡量标准的选择可能会影响识别患有衰弱和残疾的老年人。
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