title: [Validation of a prognostic model for polypathological patients (PP) in Primary Health Care: "PROFUND STUDY-AP"].
abstract: OBJECTIVE
  to validate the PROFUND index in PP in Primary Health Care (PHC).
  
  
  METHODS
  two-year prospective multicenter study.
  
  
  METHODS
  three health care centers in Seville Province (Spain).
  PP with signed informed consent.
  
  
  METHODS
  n=446 (p=20%; α=5%; β=99%); consecutive sampling.
  
  
  METHODS
  Dependent variable: mortality (2 years).
  
  
  METHODS
  socio-demography, clinic, anthropometric, laboratory, pharmacologic prescriptions, functional, cognitive and socio-familiar evaluation and the use of health resources.
  
  
  METHODS
  interview with patients and clinical charts.
  
  
  METHODS
  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.
authors.affiliation: Distrito Sanitario de Atención Primaria Aljarafe-Sevilla Norte, Sevilla, España. Electronic address: pilarbohorquez@hotmail.com.
authors.forename: Pilar Bohórquez
authors.initials: PB
authors.lastname: Colombo
authors.affiliation: UCAMI Hospitales Universitarios Virgen del Rocío, Sevilla, España.
authors.forename: María Dolores
authors.initials: MD
authors.lastname: Nieto Martín
authors.affiliation: Unidad de Gestión Clínica de Camas, Sevilla, España.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Pascual de la Pisa
authors.affiliation: Unidad de Gestión Clínica de Camas, Sevilla, España.
authors.forename: M
authors.initials: M
authors.lastname: José García Lozano
authors.affiliation: Unidad de Gestión Clínica de Camas, Sevilla, España.
authors.forename: M
authors.initials: M
authors.lastname: Angeles Ortiz Camúñez
authors.affiliation: UCAMI Hospitales Universitarios Virgen del Rocío, Sevilla, España.
authors.forename: Máximo Bernabéu
authors.initials: MB
authors.lastname: Wittel
mesh_terms: D000368:Aged; D015897:Comorbidity; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008962:Models, Theoretical; D011320:Primary Health Care; D011379:Prognosis; D011446:Prospective Studies; D013030:Spain
keywords: Atención primaria; Chronic Disease; Enfermedades Crónicas; Mortalidad; Mortality; Multimorbidity; Multimorbilidad; Primary Health Care; Prognostic score; Pronóstico