Literature DB >> 25262310

[Validation of a prognostic model for polypathological patients (PP) in Primary Health Care: "PROFUND STUDY-AP"].

Pilar Bohórquez Colombo1, María Dolores Nieto Martín2, Beatriz Pascual de la Pisa3, M José García Lozano3, M Angeles Ortiz Camúñez3, Máximo Bernabéu Wittel2.   

Abstract

AIMS: to validate the PROFUND index in PP in Primary Health Care (PHC).
DESIGN: two-year prospective multicenter study. LOCATION: three health care centers in Seville Province (Spain). SUBJECTS OF THE ASSESSMENT: PP with signed informed consent. SAMPLE: n=446 (p=20%; α=5%; β=99%); consecutive sampling. MEASUREMENT: Dependent variable: mortality (2 years). INDEPENDENT VARIABLES: socio-demography, clinic, anthropometric, laboratory, pharmacologic prescriptions, functional, cognitive and socio-familiar evaluation and the use of health resources. INFORMATION SOURCE: interview with patients and clinical charts. STATISTICAL ANALYSIS: uni and multivariate analysis according to the variables; Accuracy was assessed in the cohort by risk terciles calibration, and discrimination power, by ROC curves. Finally, accuracy of the index was compared with that of the Charlson index.
RESULTS: 446 subjects were included (53.8% men); average age was 75.44yr (Confidence interval 95% 74.58-76.31). Average of diagnostic categories was 2.37 (Confidence interval 95% 2.30-2.44). Prevalent categories were: A (64.1%), F (41.7%) and E (33.5%). Mortality within 2 years was 24.1%. Calibration in predicted/observed mortality along the three established risk strata was 16%/16.7% for PP with 0-2 points, 22%/19.5% for PP with 3-6, and 34%/36% for PP with 7 or more points (Hosmer-Lemeshow test with p=0.119). Discrimination power of PHC PROFUND's by area under the curve was (AUC) ROC was 0.622 (Confidence interval 95% 0.556-0.689; p<0.001), and that of Charlson index 0.510 (Confidence interval 95% 0.446 - 0.575; p>0.005).
CONCLUSIONS: The PROFUND index is a good indicative tool in the stratification of 2-year mortality risk polypathological patients in PHC.
Copyright © 2014 Elsevier España, S.L. All rights reserved.

Entities:  

Keywords:  Atención primaria; Chronic Disease; Enfermedades Crónicas; Mortalidad; Mortality; Multimorbidity; Multimorbilidad; Primary Health Care; Prognostic score; Pronóstico

Mesh:

Year:  2014        PMID: 25262310      PMCID: PMC8171439          DOI: 10.1016/S0212-6567(14)70064-2

Source DB:  PubMed          Journal:  Aten Primaria        ISSN: 0212-6567            Impact factor:   1.137


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