Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases

Deyo, Richard A.

doi:10.1016/0895-4356(92)90133-8

Cited by 9,475 publications

(6,283 citation statements)

References 7 publications

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“…We selected each predictor variable based on previous research or clinical experience suggesting it is an important risk factor for sepsis. We abstracted (or calculated) the following predictors from HRS survey and linked Medicare data: self reported race and ethnicity, partnership status (married or part of a couple), limitations of five activities and six instrumental activities of daily living (I/ADLs), self rating of health on a 5 point Likert scale, body mass index (BMI), wealth (sum of all assets and debts) standardized to 2013 $ using the annual gross domestic product price index,21 previous or current use of food stamps (a government assistance program for low income families and individuals), residence in a nursing home, 17 Charlson comorbidities,22 23 admissions to hospital in the previous year, and admissions for sepsis in the previous year. Limitations of activities and instrumental activities of daily living, self reported health, government assistance, and BMI were missing in 7.1%, 0.1%, 0.1%, 0.6%, and 1.3%, respectively, and these values were imputed with multiple imputation with chained equations and five imputations 24.…”

Section: Methodsmentioning

confidence: 99%

Late mortality after sepsis: propensity matched cohort study

Prescott

Osterholzer

Langa

et al. 2016

BMJ

265

214

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Objectives To determine whether late mortality after sepsis is driven predominantly by pre-existing comorbid disease or is the result of sepsis itself.Deign Observational cohort study.Setting US Health and Retirement Study.Participants 960 patients aged ≥65 (1998-2010) with fee-for-service Medicare coverage who were admitted to hospital with sepsis. Patients were matched to 777 adults not currently in hospital, 788 patients admitted with non-sepsis infection, and 504 patients admitted with acute sterile inflammatory conditions.Main outcome measures Late (31 days to two years) mortality and odds of death at various intervals.Results Sepsis was associated with a 22.1% (95% confidence interval 17.5% to 26.7%) absolute increase in late mortality relative to adults not in hospital, a 10.4% (5.4% to 15.4%) absolute increase relative to patients admitted with non-sepsis infection, and a 16.2% (10.2% to 22.2%) absolute increase relative to patients admitted with sterile inflammatory conditions (P<0.001 for each comparison). Mortality remained higher for at least two years relative to adults not in hospital.Conclusions More than one in five patients who survives sepsis has a late death not explained by health status before sepsis.

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Section: Methodsmentioning

confidence: 99%

Late mortality after sepsis: propensity matched cohort study

Prescott

Osterholzer

Langa

et al. 2016

BMJ

265

214

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“…Comorbidity and illness severity were controlled for by using the Charlson comorbidity index 7. Data were collected by the Mayo Clinic Life Science System (a data repository) and the Data Discovery and Query Builder (a query toolset; IBM) and manually reviewed by investigators.…”

Section: Methodsmentioning

confidence: 99%

Incidence and cost analysis of hospital admission and 30‐day readmission among patients with cirrhosis

Chirapongsathorn¹,

Krittanawong

Enders

et al. 2018

Hepatology Communications

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We examined risks for first hospitalization and the rate, risk factors, costs, and 1‐year outcome of 30‐day readmission among patients admitted for complications of cirrhosis. Data were retrospectively analyzed for adult patients with cirrhosis residing in Minnesota, Iowa, or Wisconsin and admitted from 2010 through 2013 at both campuses of the Mayo Clinic Hospital in Rochester, MN. Readmission was captured at the two hospitals as well as at community hospitals in the tristate area within the Mayo Clinic Health System. The incidence of hospitalization for complications of cirrhosis was 100/100,000 population, with increasing age and male sex being the strongest risks for hospitalization. For the 2,048 hospitalized study patients, the overall 30‐day readmission rate was 32%; 498 (24.3%) patients were readmitted to Mayo Clinic hospitals and 157 (7.7%) to community hospitals, mainly for complications of portal hypertension (52%) and infections (30%). Readmission could not be predicted accurately. There were 146 deaths during readmission and an additional 105 deaths up to 1 year of follow‐up (50.4% total mortality). Annual postindex hospitalization costs for those with a 30‐day readmission were substantially higher ($73,252) than those readmitted beyond 30 days ($62,053) or those not readmitted ($5,719). At 1‐year follow‐up, only 20.4% of patients readmitted within 30 days were at home. In conclusion, patients with cirrhosis have high rates of hospitalization, especially among men over 65 years, and of unscheduled 30‐day readmission. Readmission cannot be accurately predicted. Postindex hospitalization costs are high; nationally, the annual costs are estimated to be more than $4.45 billion. Only 20% of patients readmitted within 30 days are home at 1 year. (Hepatology Communications 2018;2:188–198)

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“…This score ranges from 0 to 33, with higher scores corresponding to a larger burden of comorbid conditions (Table S4). 9 Annual hospital volume of procedure was calculated by using unique hospital identification provided by NRD. We also evaluated LOS provided by NRD.…”

Section: Methodsmentioning

confidence: 99%

Causes and Predictors of Readmission in Patients With Atrial Fibrillation Undergoing Catheter Ablation: A National Population‐Based Cohort Study

Arora

Lahewala

Tripathi

et al. 2018

JAHA

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BackgroundReducing readmission after catheter ablation (CA) in atrial fibrillation (AF) is important.Methods and ResultsWe utilized National Readmission Data (NRD) 2010–2014. AF was identified by International Classification of Diseases, Ninth Edition, Clinical Modification (ICD‐9‐CM) diagnostic code 427.31 in the primary field, while first CA of AF was identified via ICD‐9‐procedure code 37.34. Any admission within 30 or 90 days of index admission was considered a readmission. Cox proportional hazard regression was used to adjust for confounders. The primary outcomes were 30‐ and 90‐day readmissions and the secondary outcome was AF recurrence. In total, 1 128 372 patients with AF were identified from January 1, 2010 to September 30, 2014. Of which 37 360 (3.3%) underwent CA. Patients aged ≥65 years and female sex were less likely to receive CA for AF. Overall, 10.9% and 16.5% of CA patients were readmitted within 30 and 90 days post‐CA, respectively. Most common causes of readmissions were arrhythmia (AF, atrial flutter), heart failure, pulmonary causes (pneumonia, chronic obstructive pulmonary disease) and bleeding complications (gastrointestinal bleed, intracranial hemorrhage). Patients with diabetes mellitus, heart failure, coronary artery disease (CAD), chronic pulmonary and kidney disease, prior stroke/transient ischemic attack (TIA), female sex, length of stay ≥2 and disposition to the facility were prone to higher 30‐ and 90‐day readmissions post‐CA. Predictors of increase in AF recurrence post‐CA were female sex, diabetes mellitus, chronic pulmonary disease, and length of stay ≥2. Trends of 90‐day readmission and AF recurrence were found to improve over the study period.ConclusionsWe identified several demographic and clinical factors associated with the use of CA in AF, and short‐term outcomes of the same, which could potentially help in the patient selection and improve outcomes.

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Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases

Cited by 9,475 publications

References 7 publications

Late mortality after sepsis: propensity matched cohort study

Late mortality after sepsis: propensity matched cohort study

Incidence and cost analysis of hospital admission and 30‐day readmission among patients with cirrhosis

Causes and Predictors of Readmission in Patients With Atrial Fibrillation Undergoing Catheter Ablation: A National Population‐Based Cohort Study

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