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Hays RD, Elliott MN. Performance of the Physical Functioning Activities of Daily Living Scale in the 2020 Medicare Health Outcomes Survey. Arch Phys Med Rehabil 2024; 105:696-703. [PMID: 37995776 PMCID: PMC11097997 DOI: 10.1016/j.apmr.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 09/06/2023] [Accepted: 11/09/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVE Assessing functional limitations for adults at high risk of frailty yields valuable information for identifying those in need of therapy. We evaluate a self-report measure used to assess physical function among Medicare recipients in the United States. DESIGN Secondary analysis of the 2020 Medicare Health Outcomes Survey. SETTING A random sample of adult enrollees of 510 managed care plans. PARTICIPANTS 287,476 adults (37% completion rate): 58% women; 16% were <65 years old (entitled via disability), 50% 65-74, and 34% 75 or older; 77% White, 14% Black, and 8% another race; 19% had INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE We evaluate item distributions, dimensionality, monotonicity of response options, reliability, and validity of the 8-item Physical Functioning Activities of Daily Living (PFADL) scale. RESULTS Most reported they could do 6 basic activities of daily living without difficulty. More limitations were reported for the other 2 PFADL items: 32% were not limited at all in climbing several flights of stairs and 40% in moderate activities. Product-moment correlations among the 8 items ranged from r=0.19 between the easiest-to-do (eating) and most difficult-to-do (climbing several flights of stairs) items to r=0.73 between bathing and dressing. The coefficient alpha and omega for the 8-item scale were both 0.86. Item slopes ranged from 2.6 (climbing several flights of stairs and eating) to 4.8 (dressing). Item characteristic curves revealed that response options were most likely to be selected in the appropriate order along the physical functioning continuum. The PFADL had at least 0.80 reliability between about -3 SDs below the mean to the mean. It was negatively correlated with comorbid condition count, disability days, problems with balance or walking, falling, and obesity. CONCLUSIONS The PFADL is useful for assessing average or below physical function in Medicare recipients.
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Affiliation(s)
- Ron D Hays
- UCLA Division of General Internal Medicine, Department of Medicine, Los Angeles, CA.
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Dhaubhadel S, Ganguly K, Ribeiro RM, Cohn JD, Hyman JM, Hengartner NW, Kolade B, Singley A, Bhattacharya T, Finley P, Levin D, Thelen H, Cho K, Costa L, Ho YL, Justice AC, Pestian J, Santel D, Zamora-Resendiz R, Crivelli S, Tamang S, Martins S, Trafton J, Oslin DW, Beckham JC, Kimbrel NA, McMahon BH. High dimensional predictions of suicide risk in 4.2 million US Veterans using ensemble transfer learning. Sci Rep 2024; 14:1793. [PMID: 38245528 PMCID: PMC10799879 DOI: 10.1038/s41598-024-51762-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 01/09/2024] [Indexed: 01/22/2024] Open
Abstract
We present an ensemble transfer learning method to predict suicide from Veterans Affairs (VA) electronic medical records (EMR). A diverse set of base models was trained to predict a binary outcome constructed from reported suicide, suicide attempt, and overdose diagnoses with varying choices of study design and prediction methodology. Each model used twenty cross-sectional and 190 longitudinal variables observed in eight time intervals covering 7.5 years prior to the time of prediction. Ensembles of seven base models were created and fine-tuned with ten variables expected to change with study design and outcome definition in order to predict suicide and combined outcome in a prospective cohort. The ensemble models achieved c-statistics of 0.73 on 2-year suicide risk and 0.83 on the combined outcome when predicting on a prospective cohort of [Formula: see text] 4.2 M veterans. The ensembles rely on nonlinear base models trained using a matched retrospective nested case-control (Rcc) study cohort and show good calibration across a diversity of subgroups, including risk strata, age, sex, race, and level of healthcare utilization. In addition, a linear Rcc base model provided a rich set of biological predictors, including indicators of suicide, substance use disorder, mental health diagnoses and treatments, hypoxia and vascular damage, and demographics.
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Affiliation(s)
| | - Kumkum Ganguly
- Los Alamos National Laboratory, Los Alamos, NM, 87545, USA
| | - Ruy M Ribeiro
- Los Alamos National Laboratory, Los Alamos, NM, 87545, USA
| | - Judith D Cohn
- Los Alamos National Laboratory, Los Alamos, NM, 87545, USA
| | - James M Hyman
- Los Alamos National Laboratory, Los Alamos, NM, 87545, USA
| | | | - Beauty Kolade
- Los Alamos National Laboratory, Los Alamos, NM, 87545, USA
| | - Anna Singley
- Los Alamos National Laboratory, Los Alamos, NM, 87545, USA
| | | | | | - Drew Levin
- Sandia National Laboratory, Albuquerque, NM, 87123, USA
| | - Haedi Thelen
- Sandia National Laboratory, Albuquerque, NM, 87123, USA
| | - Kelly Cho
- Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC), VA Boston Healthcare System, Boston, USA
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, USA
| | - Lauren Costa
- Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC), VA Boston Healthcare System, Boston, USA
| | - Yuk-Lam Ho
- Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC), VA Boston Healthcare System, Boston, USA
| | - Amy C Justice
- VA Connecticut Healthcare System, Yale Schools of Medicine and Public Health, Yale University, West Haven, CT, USA
| | - John Pestian
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Daniel Santel
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Rafael Zamora-Resendiz
- Applied Mathematics and Computational Research Division, Lawrence Berkeley National Laboratory, 1 Cyclotron Rd, Berkeley, CA, 94720, USA
| | - Silvia Crivelli
- Applied Mathematics and Computational Research Division, Lawrence Berkeley National Laboratory, 1 Cyclotron Rd, Berkeley, CA, 94720, USA
| | - Suzanne Tamang
- Program Evaluation and Resource Center, Office of Mental Health and Suicide Prevention, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, USA
- Department of Medicine, Stanford University, Stanford, California, USA
| | - Susana Martins
- Program Evaluation and Resource Center, Office of Mental Health and Suicide Prevention, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, USA
| | - Jodie Trafton
- Program Evaluation and Resource Center, Office of Mental Health and Suicide Prevention, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, USA
| | - David W Oslin
- Cpl Michael J Crescenz VA Medical Center, VISN 4 Mental Illness Research, Education, and Clinical Center; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Philadelphia, PA, 19104, USA
| | - Jean C Beckham
- Durham Veterans Affairs (VA) Health Care System, Durham, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Nathan A Kimbrel
- Durham Veterans Affairs (VA) Health Care System, Durham, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, USA
- VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
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