Comparison of three comorbidity measures for predicting health service use in patients with osteoarthritis
Comparison of three comorbidity measures for predicting health service use in patients with osteoarthritis
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DOI：
10.1002/art.21440
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发表时间：
2005-10-15
期刊：
影响因子：
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通讯作者：
Bosworth, HB
中科院分区：
文献类型：
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作者：
Dominick, KL;Dudley, TK;Bosworth, HB
目标。比较Charlson评分、Elixhaser方法和RxRisk-V这3种基于数据库的共病评分在预测骨关节炎(OA)患者的医疗服务使用方面的能力。研究人群包括306名退伍军人事务部(VA)医疗系统中接受骨性关节炎治疗的患者。使用VA住院和门诊患者数据库(Charlson Score，Elixhauser法)以及药房数据(RxRisk-V)的1年数据计算共病分数。模型选择被用来确定预测3个卫生服务使用变量的最佳共病指数：就诊次数、使用的处方数和住院概率。具体地说，Akaike的信息标准(AIC)被用来确定每个卫生服务结果变量的最佳模型。并对模型适合性进行了评估。所有三个共病指数都是每个卫生服务结果的显著预测因子(P<；0.01)。然而，基于AIC值，使用RxRisk-V和Elixhauser指数作为预测变量的模型比使用Charlson评分的模型更好。使用RxRisk-V指数作为预测因子的模型对处方药使用结果的预测效果最好，而使用Elixhauser指数的模型对医生就诊结果的预测效果最好。Rx-Risk-V和Elixhauser是检查骨性关节炎患者健康服务使用情况的合适的共病指标。这两个指数都来自行政数据库，可以有效地捕捉到大患者群体中的共病。
Objective. To compare the ability of 3 database-derived comorbidity scores, the Charlson Score, Elixhauser method, and RxRisk-V, in predicting health service use among individuals with osteoarthritis (OA).Methods. The study population comprised 306 patients who were under care for OA in the Veterans Affairs (VA) health care system. Comorbidity scores were calculated using 1 year of data from VA inpatient and outpatient databases (Charlson Score, Elixhauser method), as well as pharmacy data (RxRisk-V). Model selection was used to identify the best comorbidity index for predicting 3 health service use variables: number of physician visits, number of prescriptions used, and hospitalization probability. Specifically, Akaike's Information Criterion (AIC) was used to determine the best model for each health service outcome variable. Model fit was also evaluated.Results. All 3 comorbidity indices were significant predictors of each health service outcome (P < 0.01). However, based on AIC values, models using the RxRisk-V and Elixhauser indices as predictor variables were better than models using the Charlson Score. The model using the RxRisk-V index as a predictor was the best for the outcome of prescription medication use, and the model with the Elixhauser index was the best for the outcome of physician visits.Conclusion. The Rx-Risk-V and Elixhauser are suitable comorbidity measures for examining health services use among patients with OA. Both indices are derived from administrative databases and can efficiently capture comorbidity among large patient populations.