Comparative ability of comorbidity classification methods for administrative data to predict outcomes in patients with chronic obstructive pulmonary disease
Comparative ability of comorbidity classification methods for administrative data to predict outcomes in patients with chronic obstructive pulmonary disease
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DOI：
10.1016/j.annepidem.2012.09.011
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发表时间：
2012-12-01
影响因子：
5.6
通讯作者：
Gershon, Andrea S.
中科院分区：
文献类型：
--
作者：
Austin, Peter C.;Stanbrook, Matthew B.;Gershon, Andrea S.
目的：行政保健数据库用于卫生服务研究、比较有效性研究和测量护理质量。对并存疾病进行调整对这类研究至关重要。在慢性阻塞性肺疾病(COPD)患者的管理数据中，解释并存疾病的方法的有效性一直受到限制。我们的目标是比较Charlson指数、Elixhauser方法和Johns Hopkins聚合诊断组(ADGs)对COPD患者预后的预测能力。方法：使用加拿大安大略省COPD发病患者(n=216,735)和流行患者(n=638,926)的基于人群的管理数据构建的回顾队列，分为派生数据集和验证数据集。主要结果是1年内全死因死亡。结果：在发生和流行的慢性阻塞性肺疾病队列中，这三种方法在预测死亡率方面具有相似的区分性(查尔逊方法的验证样本中的c-统计量为0.819，Elixhauser方法为0.822，ADG方法为0.830)。结论：在疾病特定的COPD患者队列中，三种方法都可以准确预测死亡率，约翰霍普金斯大学的ADGs具有较高的识别率。(C)2012 Elsevier Inc.保留所有权利。
Purpose: Administrative healthcare databases are used for health services research, comparative effectiveness studies, and measuring quality of care. Adjustment for comorbid illnesses is essential to such studies. Validation of methods to account for comorbid illnesses in administrative data for patients with chronic obstructive pulmonary disease (COPD) has been limited. Our objective was to compare the ability of the Charlson index, the Elixhauser method, and the Johns Hopkins' Aggregated Diagnosis Groups (ADGs) to predict outcomes in patients with COPD.Methods: Retrospective cohorts constructed using population-based administrative data of patients with incident (n = 216,735) and prevalent (n = 638,926) COPD in Ontario, Canada, were divided into derivation and validation datasets. The primary outcome was all-cause death within I year. Secondary outcomes included all-cause hospitalization, COPD-specific hospitalization, non-COPD hospitalization, and COPD exacerbations.Results: In both the incident and prevalent COPD cohorts, the three methods had comparable discrimination for predicting mortality (c-statistics in the validation sample of incident patients of 0.819 for the Charlson method versus 0.822 for the Elixhauser method versus 0.830 for the ADG method). All three methods had lower predictive accuracy for predicting nonfatal outcomes.Conclusions: In a disease-specific cohort of COPD patients, all three methods allowed for accurate prediction of mortality, with the Johns Hopkins ADGs having marginally higher discrimination. (C) 2012 Elsevier Inc. All rights reserved.