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

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.)