A Revised Comorbidity Model for Administrative Databases Using Clinical Classifications Software Refined Variables

Edigin, Ehizogie

doi:10.7759/cureus.20407

Cited by 8 publications

(7 citation statements)

References 22 publications

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“…Income categories were defined as quartiles according to the median household income in the patient’s zip code. Patient comorbidities were computed using a weighted Elixhauser Comorbidity Index . Lastly, we created a new variable called care discontinuity.…”

Section: Methodsmentioning

confidence: 99%

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Patient and Hospital Characteristics Associated With Delayed Diagnosis of Appendicitis

et al. 2023

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ImportanceRacial disparities in timely diagnosis and treatment of surgical conditions exist; however, it is poorly understood whether there are hospital structural measures or patient-level characteristics that modify this phenomenon.ObjectiveTo assess whether patient race and ethnicity are associated with delayed appendicitis diagnosis and postoperative 30-day hospital use and whether there are patient- or systems-level factors that modify this association.Design, Setting, and ParticipantsThis population-based, retrospective cohort study used data from the Healthcare Cost and Utilization Project’s state inpatient and emergency department (ED) databases from 4 states (Florida, Maryland, New York, and Wisconsin) for patients aged 18 to 64 years who underwent appendectomy from January 7, 2016, to December 1, 2017. Data were analyzed from January 1, 2016, to December 31, 2017.ExposureDelayed diagnosis of appendicitis, defined as an initial ED presentation with an abdominal diagnosis other than appendicitis followed by re-presentation within a week for appendectomy.Main Outcomes and MeasuresA mixed-effects multivariable Poisson regression model was used to estimate the association of delayed diagnosis of appendicitis with race and ethnicity while controlling for patient and hospital variables. A second mixed-effects multivariable Poisson regression model quantified the association of delayed diagnosis of appendicitis with postoperative 30-day hospital use.ResultsOf 80 312 patients who received an appendectomy during the study period (median age, 38 years [IQR, 27-50 years]; 50.8% female), 2013 (2.5%) experienced delayed diagnosis. In the entire cohort, 2.9% of patients were Asian or Pacific Islander, 18.8% were Hispanic, 10.9% were non-Hispanic Black, 60.8% were non-Hispanic White, and 6.6% were other race and ethnicity; most were privately insured (60.2%). Non-Hispanic Black patients had a 1.41 (95% CI, 1.21-1.63) times higher adjusted rate of delayed diagnosis compared with non-Hispanic White patients. Patients at hospitals with a more than 50% Black or Hispanic population had a 0.73 (95% CI, 0.59-0.91) decreased adjusted rate of delayed appendicitis diagnosis compared with hospitals with a less than 25% Black or Hispanic population. Conversely, patients at hospitals with more than 50% of discharges of Medicaid patients had a 3.51 (95% CI, 1.69-7.28) higher adjusted rate of delayed diagnosis compared with hospitals with less than 10% of discharges of Medicaid patients. Additional factors associated with delayed diagnosis included female sex, higher levels of patient comorbidity, and living in a low-income zip code. Delayed diagnosis was associated with a 1.38 (95% CI, 1.36-1.61) increased adjusted rate of postoperative 30-day hospital use.Conclusions and RelevanceIn this cohort study, non-Hispanic Black patients had higher rates of delayed appendicitis diagnosis and 30-day hospital use than White patients. Patients presenting to hospitals with a greater than 50% Black and Hispanic population were less likely to experience delayed diagnosis, suggesting that seeking care at a hospital that serves a diverse patient population may help mitigate the increased rate of delayed diagnosis observed for non-Hispanic Black patients.

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Section: Methodsmentioning

confidence: 99%

“…Patient comorbidities were computed using a weighted Elixhauser Comorbidity Index. 16,17 Lastly, we created a new variable called care discontinuity. This variable was defined as a dichotomous variable indicating whether or not the patient had their appendectomy at the same or different hospital than their initial encounter.…”

Section: Variable Definitionmentioning

confidence: 99%

Patient and Hospital Characteristics Associated With Delayed Diagnosis of Appendicitis

et al. 2023

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“…Variables with p-values <0.01 were subsequently included in the final multivariate regression model (stricter entry criteria were implemented given large database analysis). This was done to avoid overpowering and avoid variables attaining statistical significance while only marginally changing the outcome [15].…”

Section: Discussionmentioning

confidence: 99%

Racial Disparities in Patients With COVID-19 Infection: A National Inpatient Sample Analysis

Vardar¹,

Ilelaboye²,

Murthi³

et al. 2023

Cureus

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IntroductionEvidence suggests the COVID-19 (coronavirus disease 2019) pandemic highlighted well-known healthcare disparities. This study investigated racial disparities in patients with COVID-19-related hospitalizations utilizing the US (United States) National Inpatient Sample (NIS). MethodologyThis was a retrospective study conducted utilizing the NIS 2020 database. The NIS was searched for hospitalization of adult patients with COVID-19 infection as a principal diagnosis using ICD-10 (International Classification of Diseases, Tenth Revision) codes. We divided the NIS into four major racial/ethnic groups: White, Black, Hispanic, and others. The primary outcome was inpatient mortality, and the secondary outcomes were the mean length of stay, mean total hospital charges, development of sepsis, septic shock, use of vasopressors, acute respiratory failure, acute respiratory distress syndrome, acute kidney failure, acute myocardial infarction, cardiac arrest, deep vein thrombosis, pulmonary embolism, cerebrovascular accident, and need for mechanical ventilation. ResultsCompared to White patients, Hispanic patients had higher adjusted inpatient mortality odds (aOR [adjusted odds ratio]: 1.25, 95% CI 1.19-1.33, p<0.001); however, Black patients had similar adjusted mortality odds (aOR: 0.96, 95% CI 0.91-1.01, p=0.212). Black patients and Hispanic patients had a higher mean length of

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“…It also contains hospital-specific variables including bed size, teaching status and location. We assessed the comorbidity burden using the Elixhauser Comorbidity Index (ECI) 12 13…”

Section: Methodsmentioning

confidence: 99%

Gender disparities, causes and predictors of immediate and short-term cardiovascular readmissions following COVID-19-related hospitalisations in the USA

Vardar,

Shaka,

Kumi

et al. 2023

BMJ Open

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ObjectivesIn this study, we aimed to identify the causes, predictors and gender disparities of 30-day and 90-day cardiovascular readmissions after COVID-19-related hospitalisations using National Readmission Database (NRD) 2020.SettingWe used the NRD from 2020 to identify hospitalised adults with a principal diagnosis of COVID-19 infection.ParticipantsWe included subjects who were readmitted within 30 days and 90 days after index admission. We excluded subjects with elective and traumatic admissions. We used a multivariate Cox regression model to identify independent predictors of readmission.Primary and secondary outcomes measuresOur outcomes were inpatient mortality, 30-day and 90-day cardiovascular readmission rates following COVID-19 infection.ResultsDuring the study period, there were 1 024 492 index hospitalisations with a primary diagnosis of COVID-19 infection in the 2020 NRD database, 644 903 (62.9%) were included for 30-day readmission analysis, and 418 122 (40.8%) were included for 90-day readmission analysis. Of patients involved in the 30-day analysis, 7140 (1.1%) patients had a readmission within 30 days; of patients involved in the 90-day analysis, 8379 (2.0%) had a readmission within 90 days due to primarily cardiovascular causes. Cox regression analysis revealed that the female sex (aHR 0.89; 95% CI 0.82 to 0.95; p=0.001) was associated with a lower hazard of 30-day cardiovascular readmissions; however, congestive heart failure (aHR 2.45; 95% CI 2.2 to 2.72; p<0.001), arrhythmias (aHR 2.45; 95% CI 2.2 to 2.72; p<0.001) and valvular disease (aHR 2.45; 95% CI 2.2 to 2.72; p<0.001) had a higher hazard. The most common causes of cardiovascular readmissions were heart failure (34.3%), deep vein thrombosis/pulmonary embolism (22.5%) and atrial fibrillation (9.5%).ConclusionOur study demonstrates that male gender, heart failure, arrhythmias and valvular disease carry higher hazards of 30-day and 90-day cardiovascular readmissions. Identifying risk factors and common causes of readmission may assist with lowering the burden of cardiovascular disease in patients with COVID-19 infection.

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A Revised Comorbidity Model for Administrative Databases Using Clinical Classifications Software Refined Variables

Cited by 8 publications

References 22 publications

Patient and Hospital Characteristics Associated With Delayed Diagnosis of Appendicitis

Patient and Hospital Characteristics Associated With Delayed Diagnosis of Appendicitis

Racial Disparities in Patients With COVID-19 Infection: A National Inpatient Sample Analysis

Gender disparities, causes and predictors of immediate and short-term cardiovascular readmissions following COVID-19-related hospitalisations in the USA

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