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Reliability and usability of a weighted version of the Functional Comorbidity Index

Authors Kabboord AD, van Eijk M, van Dingenen L, Wouters M, Koet M, van Balen R, Achterberg WP

Received 23 August 2018

Accepted for publication 14 November 2018

Published 11 February 2019 Volume 2019:14 Pages 289—299

DOI https://doi.org/10.2147/CIA.S185112

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 2

Editor who approved publication: Dr Richard Walker


Anouk D Kabboord,1 Monica van Eijk,1,2 Lisette van Dingenen,1 Monique Wouters,1 Marieke Koet,1 Romke van Balen,1 Wilco P Achterberg1

1Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands; 2Department of Old-Age Medicine Hubertusduin, HMC Bronovo, The Hague, the Netherlands

Purpose: To investigate the reliability of a weighted version of the Functional Comorbidity Index (w-FCI) compared with that of the original Functional Comorbidity Index (FCI) and to test its usability.
Patients and methods: Sixteen physicians collected data from 102 residents who lived in 16 different nursing homes in the Netherlands. A multicenter, prospective observational study was carried out in combination with a qualitative part using the three-step test interview, in which participants completed the w-FCI while thinking aloud and being observed, and were then interviewed afterward. To analyze inter-rater reliability, a subset of 41 residents participated. The qualitative part of the study was completed by eleven elderly care physicians and one advanced nurse practitioner.
Measurements: The w-FCI was composed of the original FCI supplemented with a severity rating per comorbidity, ranging from 0 (disease absent) to 3 (severe impact on daily function). The w-FCI was filled out at baseline by 16 physicians and again 2 months later to establish intra-rater reliability (intraclass correlations; ICCs). For inter-rater reliability, four pairs of raters completed the w-FCI independently from each other.
Results: The ICCs were 0.90 (FCI) and 0.94 (w-FCI) for intra-rater reliability, and 0.61 (FCI) and 0.55 (w-FCI) for inter-rater reliability. Regarding usability of the w-FCI, five meaningful themes emerged from the qualitative data: 1) sources of information; 2) deciding on the presence or absence of disease; 3) severity of comorbidities; 4) usefulness; and 5) content.
Conclusion: The intra-rater reliability of the FCI and the w-FCI was excellent, whereas the inter-rater reliability was moderate for both indices. Based on the present results, a modified w-FCI is proposed that is acceptable and feasible for use in older patients and requires further investigation to study its (predictive) validity.

Keywords: older patients, multimorbidity, personalized medicine, function, disease impact

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