Comparing the performance of the Charlson/Deyo and Elixhauser comorbidity measures across five European countries and three conditions
Comparing the performance of the Charlson/Deyo and Elixhauser comorbidity measures across five European countries and three conditions
复制标题
DOI：
10.1093/eurpub/cku221
复制
发表时间：
2015-02-01
影响因子：
4.4
通讯作者：
Cookson, Richard
中科院分区：
文献类型：
--
作者：
Gutacker, Nils;Bloor, Karen;Cookson, Richard
背景：Charlson和Elixhauser共病测量是使用管理数据在医院水平的临床质量比较中解释患者共病的常用方法。这两种方法都在北美得到了验证，但在欧洲和汇集的跨国数据（欧洲医疗保健优化合作（ECHO）项目的特点）中，它们的表现证据较少。本研究比较了Charlson/Deyo和Elixhauser合并症测量在预测住院死亡率方面的表现，使用了来自五个欧洲国家三个住院病人组的数据。方法：采用2008-2009年五个国家的行政数据，比较医院质量比较常用的三个指标：急性心肌梗死、冠状动脉搭桥手术和中风后死亡率。建立了逻辑回归模型来预测控制年龄、性别和相关合并症措施的死亡率。使用c统计量评估模型判别。使用校准斜率评估模型校准。使用Nagelkerke的R-2和Akaike信息准则评估总体拟合优度。所有模型在内部通过使用自举进行验证，外部通过使用2009年模型参数预测2008年的死亡率进行验证。结果：Elixhauser测量法在辨别性和拟合优度方面比Charlson/Deyo测量法和年龄-性别模型具有更好的整体预测能力。模型标定没有明显差异。这些发现对于国家的选择、对所有五个国家的汇总以及内部和外部验证都是稳健的。结论：Elixhauser量表包含更多的合并症，这可能使其比Charlson量表具有更好的鉴别效果。两种测量方法都达到了相似的校准，因此对于ECHO的目的，我们判断Elixhauser测量方法更可取。
Background: The Charlson and Elixhauser comorbidity measures are commonly used methods to account for patient comorbidities in hospital-level comparisons of clinical quality using administrative data. Both have been validated in North America, but there is less evidence of their performance in Europe and in pooled cross-country data, which are features of the European Collaboration for Healthcare Optimization (ECHO) project. This study compares the performance of the Charlson/Deyo and Elixhauser comorbidity measures in predicting in-hospital mortality using data from five European countries in three inpatient groups. Methods: Administrative data is used from five countries in 2008-2009 for three indicators commonly used in hospital quality comparisons: mortality rates following acute myocardial infarction, coronary artery bypass graft surgery and stroke. Logistic regression models are constructed to predict mortality controlling for age, gender and the relevant comorbidity measure. Model discrimination is evaluated using c-statistics. Model calibration is evaluated using calibration slopes. Overall goodness-of-fit is evaluated using Nagelkerke's R-2 and the Akaike information criterion. All models are validated internally by using bootstrapping and externally by using the 2009 model parameters to predict mortality in 2008. Results: The Elixhauser measure has better overall predictive ability in terms of discrimination and goodness-of-fit than the Charlson/Deyo measure or the age-sex only model. There is no clear difference in model calibration. These findings are robust to the choice of country, to pooling all five countries and to internal and external validation. Conclusions: The Elixhauser list contains more comorbidities, which may enable it to achieve better discrimination than the Charlson measure. Both measures achieve similar calibration, so for the purpose of ECHO we judged the Elixhauser measure to be preferable.