Variations in the Associations Between Psychiatric Comorbidity and Hospital Mortality According to the Method of Identifying Psychiatric Diagnoses

Abrams, Thad E.; Vaughan-Sarrazin, Mary; Rosenthal, Gary E.

doi:10.1007/s11606-008-0518-z

Cited by 31 publications

(28 citation statements)

References 33 publications

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“…Some investigators have supplemented diagnoses on the inpatient record with diagnoses from prior health care encounters (Krumholz & Normand, 2008), which may minimize the impact of coding bias that exists on admission records. Nevertheless, this approach is often difficult to operationalize and may yield widely different estimates of the impact of the comorbid condition on outcomes (Abrams, Vaughan Sarrazin, Rosenthal, et al, 2008). In addition, the use of risk-adjustment for performance measurement usually creates incentives for hospitals to record all indicators of comorbidity in order to make patients appear 'sicker'.…”

Section: Discussionmentioning

confidence: 99%

The impact of paradoxical comorbidities on risk-adjusted mortality of Medicare beneficiaries with cardiovascular disease

Vaughan-Sarrazin

Lü

Cram

2011

MMRR

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Background: Persistent uncertainty remains regarding assessments of patient comorbidity based on administrative data for mortality risk adjustment. Some models include comorbid conditions that are associated with improved mortality while other models exclude these so-called paradoxical conditions. The impact of these conditions on patient risk assessments is unknown.Objective: To examine trends in the prevalence of conditions with a paradoxical (protective) relationship with mortality, and the impact of including these conditions on assessments of risk adjusted mortality. Methods:Patients age 65 and older admitted for acute myocardial infarction (AMI) or coronary artery bypass graft (CABG) surgery during 1994 through 2005 were identified in Medicare Part A files. Comorbid conditions defined using a common algorithm were categorized as having a paradoxical or non-paradoxical relationship with 30-day mortality, based upon regression coefficients in multivariable logistic regression models.Results: For AMI, the proportion of patients with one or more paradoxical condition and one or more non-paradoxical condition increased by 24% and 3% respectively between 1994 and 2005. The odds of death for patients with one-or-more paradoxical comorbidities, relative to patients with no paradoxical comorbidity, declined from 0.69 to 0.54 over the study period. In contrast, the risk associated with having one or more non-paradoxical comorbidities increased from 2.66 to 4.62 for AMI. This pattern was even stronger for CABG. Risk adjustment models that included paradoxical comorbidities found larger improvements, in risk-adjusted mortality for AMI and CABG, over time than models that did not include paradoxical comorbidities. Conclusion:The relationship between individual comorbid conditions and mortality is changing over time, with potential impact on estimates of hospital performance and trends in mortality. Development of a standard approach for handling conditions with a paradoxical relationship to mortality is needed.

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Section: Discussionmentioning

confidence: 99%

The impact of paradoxical comorbidities on risk-adjusted mortality of Medicare beneficiaries with cardiovascular disease

Vaughan-Sarrazin

Lü

Cram

2011

MMRR

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“…Level 2 and 3 social factors were examined less frequently. However, those that did found that the presence of psychiatric comorbidity paradoxically decreased mortality 29 but there was no impact of income. 8 Only one Level 3 social factor, being a nursing home resident, significantly increased the odds of mortality (OR=1.5).…”

Section: Social Factors Associated With Mortality In Pneumoniamentioning

confidence: 97%

“…9,27,37,51 Level 2 factors that were examined but were not significant included insurance, 57 education, 55 and socioeconomic status. 45 Abrams et al 29 showed that patients with a psychiatric comorbidity had decreased odds of mortality. Level 3 factors examined included non-adherence behavior; diet non-adherence 58 and medical plan non-adherence 59 were associated with decreased short-term mortality, while medication non-adherence 58 showed no difference.…”

Section: Social Factors Associated With Mortality In Heart Failurementioning

confidence: 99%

Impact of Social Factors on Risk of Readmission or Mortality in Pneumonia and Heart Failure: Systematic Review

et al. 2012

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“…On the basis of prior research, ICD-9 codes were used to identify several key comorbid psychiatric conditions: traumatic brain injury (TBI), depression, anxiety, and alcohol or drug abuse. The ICD-9 codes can be viewed in Table E1 (online) (18).…”

Section: Key Independent Variablesmentioning

confidence: 99%

Patterns of Illness Explaining the Associations between Posttraumatic Stress Disorder and the Use of CT

Abrams¹,

Vaughan-Sarrazin²,

Richardson³

et al. 2013

Radiology

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Purpose:To examine the relationship between posttraumatic stress disorder (PTSD) and computed tomography (CT) utilization and to determine whether there were patterns of comorbid illness that could explain the relationship. Materials and Methods:The study was approved by the University of Iowa Institutional Review Board and the Iowa City Veterans Affairs Medical Center Research and Development Committee. By using a retrospective cohort design, a national sample of new veteran enrollees aged 18-35 years was studied. Associations were examined between the presence of PTSD, receipt of at least one and multiple CT scans, comorbid medical conditions (eg, abdominal pain, headaches), and measures of health care utilization (eg, primary care, emergency room, and mental health visits) and the daily probability of the receipt of at least one CT scan before and after a diagnosis of PTSD. Analyses included sequential multivariable generalized linear mixed models to examine the independent relationship between PTSD and CT scan utilization. Results:Among the full cohort, 13.0% (10 018 of 76 812) received at least one CT scan. PTSD was identified in 21.1% (16 182 of 76 812) of the cohort, and 22.9% (3711 of 16 182) of veterans with PTSD received at least one CT scan as compared with 10.4% (6307 of 60 630) of veterans without PTSD (P , .0001). In sequential modeling, comorbid factors explaining the relationship between CT scans and PTSD were traumatic brain injury (odds ratio, 3.54; P , .0001), abdominal pain (odds ratio, 4.01; P , .0001), and headaches (odds ratio, 3.07; P , .0001). Associations were also strong for high levels of emergency room (odds ratio, 2.73; P , .0001) and primary care (odds ratio, 2.38; P , .0001) utilization. The daily chance of receiving a CT scan was seven times higher prior to the recognition of PTSD (daily chance, 0.007 before vs 0.001 after; P , .0001). Conclusion:Young veterans with PTSD are receiving more CT scans compared with those without PTSD; the daily probability of receiving CT scans is higher prior to recognition of PTSD.q RSNA, 2013 Supplemental material: http://radiology.rsna.org/lookup /suppl

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Variations in the Associations Between Psychiatric Comorbidity and Hospital Mortality According to the Method of Identifying Psychiatric Diagnoses

Cited by 31 publications

References 33 publications

The impact of paradoxical comorbidities on risk-adjusted mortality of Medicare beneficiaries with cardiovascular disease

The impact of paradoxical comorbidities on risk-adjusted mortality of Medicare beneficiaries with cardiovascular disease

Impact of Social Factors on Risk of Readmission or Mortality in Pneumonia and Heart Failure: Systematic Review

Patterns of Illness Explaining the Associations between Posttraumatic Stress Disorder and the Use of CT

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