Concordance of Cornell medical index self-reports to structured clinical assessment for the identification of physical health status.

Self-reported questionnaires are frequently used to assess health status in epidemiological studies. The Cornell medical index is one such tool used to determine the presence of physical and psychiatric illness but its accuracy and value have been questioned. In this study we have assessed the ability of the CMI to predict health status in two separate patient populations (n = 101, 88) by comparison to a structured medical assessment based on the SENIEUR protocol by two physicians. There was good agreement between medication use reported on the CMI and on medical assessment (k = 0.79; CI: 0.70-0.88). Accuracy of prediction of the CMI for specific medical conditions was good 89-99%. A threshold score from the CMI was not predictive of health as determined by the SENIEUR protocol. In our older populations, we conclude that the CMI accurately predicted health status. The determination of normal health by a threshold score was poorly predictive of heath status. Self-reported medication use was the best predictor of health status.

Predictors of outcome following hip fracture. Admission time predicts length of stay and in-hospital mortality.

Many factors may contribute to the mortality and morbidity following hip fracture, including the provision of care. We wished to examine the contribution of potential factors to in-hospital mortality, length of hospital stay and 90-day mortality by statistical analyses of an audit database of all hip fractures admitted to a teaching hospital following the introduction of a fast track admission system. In-hospital mortality was predicted by ASA grade, the presence of any complications, cardiovascular complications, grade of surgeon, operation type and shorter admission time, a measure of time taken to admit a patient to a hospital bed (P<0.001). Length of hospital stay was predicted by increased age, presence of chronic cognitive impairment/dementia, presence of an implant complication, operation type, fracture type and longer admission time, r=0.455, P<0.001. Ninety-day mortality was predicted by the presence of chronic cognitive impairment/dementia, cardiovascular complications, pulmonary complications, ASA grade, grade of surgeon and admission day, P<0.001. Rapid admission following a hip fracture may not be the ideal management approach for all patient groups. Further study is required to identify factors in the process of care which are associated with better outcomes.