Comorbidity measures for use with administrative data
Comorbidity measures for use with administrative data
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DOI：
10.1097/00005650-199801000-00004
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发表时间：
1998-01-01
期刊：
影响因子：
3
通讯作者：
Coffey, RN
中科院分区：
文献类型：
--
作者：
Elixhauser, A;Steiner, C;Coffey, RN
目标。这项研究试图开发一套全面的共病测量方法，用于管理住院患者的大量数据。方法：这项研究包括对共病测量方法的临床和经验回顾，开发一个试图将共病与患者病情的其他方面分开的框架，开发一种共病算法，以及对不同和同质的患者群体进行测试。数据来自1992年加利福尼亚州438家急性护理医院的所有成人、非产妇住院患者(n=1,779,167)。结果：结果测量通常在管理数据中可用：住院时间、住院费用和住院死亡。结果：制定了一套全面的30项共病测量方法。在异质性和同质性疾病组中，合并症与住院时间、住院费用和死亡率的大幅增加有关。描述了几种共病，它们是预后的重要预测因素，但通常无法测量。这些疾病包括精神障碍、药物和酒精滥用、肥胖、凝血障碍、体重减轻以及液体和电解质紊乱。结论：这些并发症对预后有独立的影响，可能不应该简化为一个指标，因为它们对不同患者组的预后有不同的影响。本方法解决了以前措施的一些局限性。它基于一种确定合并症的综合方法，并将其与住院的主要原因分开，从而扩大了一组合并症，无需进一步完善各种疾病的管理数据，即可轻松应用。
OBJECTIVES. This study attempts to develop a comprehensive set of comorbidity measures for use with large administrative inpatient datasets.METHODS. The study involved clinical and empirical review of comorbidity measures, development of a framework that attempts to segregate comorbidities from other aspects of the patient's condition, development of a comorbidity algorithm, and testing on heterogeneous and homogeneous patient groups. Data were drawn from all adult, nonmaternal inpatients from 438 acute care hospitals in California in 1992 (n = 1,779,167). Outcome measures were those commonly available in administrative data: length of stay, hospital charges, and in-hospital death.RESULTS. A comprehensive set of 30 comorbidity measures was developed. The comorbidities were associated with substantial increases in length of stay, hospital charges, and mortality both for heterogeneous and homogeneous disease groups. Several comorbidities are described that are important predictors of outcomes, yet commonly are not measured. These include mental disorders, drug and alcohol abuse, obesity, coagulopathy, weight loss, and fluid and electrolyte disorders.CONCLUSIONS. The comorbidities had independent effects on outcomes and probably should not be simplified as an index because they affect outcomes differently among different patient groups. The present method addresses some of the limitations of previous measures. It is based on a comprehensive approach to identifying comorbidities and separates them from the primary reason for hospitalization, resulting in an expanded set of comorbidities that easily is applied without further refinement to administrative data for a wide range of diseases.