Sharon Ostfeld-Johns: Creating a New Tool BACK

Published by AFAR

When I first went to shadow a geriatrician this summer, it wasn’t the clinical aspects of my experience that were the most memorable. I did witness an excellent clinician balancing a myriad of concerns for the patients that made up his afternoon appointments. I saw his kindness and openness, and how important it was to the patients to tell me how wonderful he was, and about the health problems he had helped them with or seen them through. But the most memorable part was witnessing a situation in which the research aspect of my MSTAR program could help solve a problem. Another geriatrician in the practice was having an email exchange with a physician in another specialty over a conflict that arose due to the recent institution of electronic medical records in the hospital. Apparently, an expensive diagnostic test was required according to the electronic system if a certain set of criteria were entered in a patient’s record. The geriatrician argued that often, in his patient population – older, frail, with multiple comorbid diseases – the results of the diagnostic test would not result in a change in his management of their problems, and therefore, he wanted additional options that would allow him to use his clinical judgment and not be cited for “failing” to provide required care.

The goal of my summer research project is to design, from a database of information on outpatient geriatric patients, a tool that would improve the predictive validity of the widely used Charlson comorbidity tool. Using an input of health status (a number of diseases and conditions), self-report of health status (poor/fair, good/excellent), functional status (number of independent activities of daily living and instrumental activities of daily living, gait status), and geriatric syndromes (falls, dysphagia), the tool will generate a prognostic value – it would predict the probability of several outcomes within a number of years. The outcomes include death, nursing home admission, fall, hip fracture, and hospitalization. A simple prognosticator with accurate and helpful information would enable good use of available input, and allow excellent medical decision-making, hospital administration, quality control and research, and preventive medicine. Updating the Charlson comorbidity tool to encompass characteristics other than diseases both improves its predictive validity, making it a more useful tool, but it also incorporates factors of medicine that have long been recognized by geriatricians to be much more predictive than disease diagnosis alone.

I realized in the clinical office a perfect application for the comorbidity tool that had been to me, until that moment, only a spreadsheet full of data.

Sharon Ostfeld-Johns
University of Rochester School of Medicine

"Diary of an MSTAR Student" follows scholars in the 2011 Medical Student Training in Aging Research (MSTAR) Program, highlighting their summer experiences. As they continue their path of research, training and clinical practice, read their daily thoughts at www.afar.org/mstarblog. New diary entries are posted every day, so check back soon.