Een gevalideerd screeningsinstrument voorspelt functieverlies bij thuiswonende ouderen: de Identification of Seniors at Risk--Primary Care (ISAR-PC)

To modify and validate in primary healthcare the Identification of Seniors At Risk (ISAR) screening questionnaire to identify older persons at increased risk of functional decline and to compare this strategy with risk stratification by age alone. Prospective development (n=790) and validation cohorts (n=2,573) of community-dwelling persons aged ≥70 years. Functional decline at 12 months was defined as an increase of at least one point on the modified Katz-activities of daily living index score compared with baseline or death. Three items were independently associated with functional decline: age (odds ratio [OR] 1.06 per year; 95% confidence interval [CI] 1.02, 1.10) dependence in instrumental activities of daily living (OR: 2.17; 95% CI: 1.46, 3.22), and impaired memory (OR: 2.22; 95% CI: 1.41, 3.51). The area under the receiver operating characteristics curve (AUC) range of the ISAR-primary care model was 0.67-0.70 and 40.6% was identified at increased risk. Validation yielded an AUC range of 0.63-0.64. Age≥75 years alone yielded an AUC range of 0.56-0.57 and identified 65.0% at increased risk in the validation cohort. Although the ISAR-Primary Care (ISAR-PC) has moderate predictive value, application of the ISAR-PC is more efficient than selection based on age alone in identifying persons at increased risk of functional decline. This paper is a translated and adjusted version based on a publication in Journal of Clinical Epidemiology, 67 (2014) 1121-113

Self-Report of Healthcare Utilization among Community-Dwelling Older Persons: A Prospective Cohort Study

<div><p>Background</p><p>Self-reported data are often used for estimates on healthcare utilization in cost-effectiveness studies.</p><p>Objective</p><p>To analyze older adults’ self-report of healthcare utilization compared to data obtained from the general practitioners’ (GP) electronic medical record (EMR) and to study the differences in healthcare utilization between those who completed the study, those who did not respond, and those lost to follow-up.</p><p>Methods</p><p>A prospective cohort study was conducted among community-dwelling persons aged 70 years and above, without dementia and not living in a nursing home. Self-reporting questionnaires were compared to healthcare utilization data extracted from the EMR at the GP-office.</p><p>Results</p><p>Overall, 790 persons completed questionnaires at baseline, median age 75 years (IQR 72–80), 55.8% had no disabilities in (instrumental) activities of daily living. Correlations between self-report data and EMR data on healthcare utilization were <i>substantial</i> for ‘hospitalizations’ and ‘GP home visits’ at 12 months intraclass correlation coefficient 0.63 (95% CI; 0.58–0.68). Compared to the EMR, self-reported healthcare utilization was generally slightly over-reported. Non-respondents received more GP home visits (p<0.05). Of the participants who died or were institutionalized 62.2% received 2 or more home visits (p<0.001) and 18.9% had 2 or more hospital admissions (p<0.001) versus respectively 18.6% and 3.9% of the participants who completed the study. Of the participants lost to follow-up for other reasons 33.0% received 2 or more home visits (p<0.01) versus 18.6 of the participants who completed the study.</p><p>Conclusions</p><p>Self-report of hospitalizations and GP home visits in a broadly ‘healthy’ community-dwelling older population seems adequate and efficient. However, as people become older and more functionally impaired, collecting healthcare utilization data from the EMR should be considered to avoid measurement bias, particularly if the data will be used to support economic evaluation.</p></div

Mean healthcare utilizaton in 2009 extracted from the EMR and the mean time not in the study with increasing number of (I)ADL disabilities (n = 790).

<p>Mean healthcare consumption with 95%CI.</p

The numbers of self-reported hospitalization and hospitalization according to the Electronic Medical Record at 12 months.

<p>The numbers of self-reported hospitalization and hospitalization according to the Electronic Medical Record at 12 months.</p

The numbers of self-reported GP-homevisits and GP-homevisits according to the Electronic Medical Record at 12 months.

<p>The numbers of self-reported GP-homevisits and GP-homevisits according to the Electronic Medical Record at 12 months.</p

Flowchart.

<p>*Non-respondents were those we were unable to contact at baseline. Those who are denoted as ‘unable to contact’ are those persons not responding at follow-up. † These numbers represent a variable group of persons since persons who did not respond at three months follow up, might respond at a later follow-up moment.</p

Agreement between self-reported and Electronic Medical Record healthcare utilization at 12 months.

†<p><i>Values are numbers and percentages between brackets, unless otherwise noted.</i></p><p><i>*self-reported data and EMR data indicated no event.</i></p><p><i>GP  =  general practitioner; EMR  =  electronic medical record; IQR  =  inter quartile range; ICC  =  intraclass correlation coefficients; CI  =  confidence interval.</i></p

Healthcare utilization of participants compared to those lost to follow-up.

†<p>Values are percentages.</p><p>The chi-square test was used for ordinal variables.</p><p><i>*p≤0.05.</i></p><p><i>**p≤0.01.</i></p><p><i>***p≤0.001 compared to respondents. Significant differences are marked in bold.</i></p

Baseline characteristics of participants compared to those lost to follow-up (percentages).

†<p><i>Values are percentages unless otherwise noted.</i></p><p><i>The Mann-Whitney U test was used for continuous variables. The chi-square test was used for binary or ordinal variables.</i></p><p><i>*p≤0.05.</i></p><p><i>**p≤0.01.</i></p><p>***p≤0.001 compared to respondents. Significant differences are marked in bold.</p