In search of the perfect comorbidity measure for use with administrative claims data - Does it exist?
In search of the perfect comorbidity measure for use with administrative claims data - Does it exist?
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DOI：
10.1097/01.mlr.0000223475.70440.07
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发表时间：
2006-08-01
期刊：
影响因子：
3
通讯作者：
Wright, George
中科院分区：
文献类型：
--
作者：
Baldwin, Laura-Mae;Klabunde, Carrie N.;Wright, George
背景：许多措施的共病已经制定了卫生服务研究与行政索赔。目的：我们试图比较4种基于索赔的共病指标的性能。目的：我们试图比较4种基于索赔的共病指标的性能。研究设计和受试者：我们对1992年1月1日至12月31日期间向监测、流行病学和最终结果项目报告的5777名66岁及以上III期结肠癌医疗保险受益人进行了回顾性队列研究，1996.Results:对于所有指标，合并症越多，化疗的接受率越低，非癌症死亡率越高。嵌套逻辑回归模型表明，使用更多的索赔来源来衡量合并症，一般提高化疗接收和非癌症死亡的预测，但取决于措施的类型和研究的结果。所有4项共病指标均显著改善了基线回归模型对两种化疗治疗的拟合度。（基线c-统计量0.776;范围从添加ACG和Klabunde后的0.779至Elixhauser后的0.789）和非癌症死亡（基线c-统计量为0.687;范围从添加ACG后的0.717到Elixhauser后的0.744）。虽然一些合并症的措施表现出较小的优势，比别人，每一个都是相当强大的预测化疗和非癌症死亡。研究者应根据这些指标的可用性、对方法的舒适度和感兴趣的结果进行选择。
Background: Numerous measures of comorbidity have been developed for health services research with administrative claims. Objective: We sought to compare the performance of 4 claims-based comorbidity measures.Objective: We sought to compare the performance of 4 claims-based comorbidity measures.Research Design and Subjects: We undertook a retrospective cohort study of 5777 Medicare beneficiaries ages 66 and older with stage III colon cancer reported to the Surveillance, Epidemiology, and End Results Program between January 1, 1992 and December 31, 1996.Results: For all measures, greater comorbidity significantly predicted lower receipt of chemotherapy and higher noncancer death. Nested logistic regression modeling suggests that using more claims sources to measure comorbidity generally improves the prediction of chemotherapy receipt and noncancer death, but depends on the measure type and outcome studied. All 4 comorbidity measures significantly improved the fit of baseline regression models for both chemotherapy receipt (baseline c-statistic 0.776; ranging from 0.779 after adding ACGs and Klabunde to 0.789 after Elixhauser) and noncancer death (baseline c-statistic 0.687; ranging from 0.717 after adding ACGs to 0.744 after Elixhauser).Conclusions: Although some comorbidity measures demonstrate minor advantages over others, each is fairly robust in predicting both chemotherapy receipt and noncancer death. Investigators should choose among these measures based on their availability, comfort with the methodology, and outcomes of interest.