Consistency of performance ranking of comorbidity adjustment scores in canadian and U.S. utilization data
Journal of General Internal MedicinePublished 30 April 2004Open access
Sebastian Schneeweiß, Philip S. Wang, Jerry Avorn, Malcolm Maclure, Raia Levin, Robert J. Glynn
Citations80
SJR quartileQ1
SJR score1.99
SNIP1.71
Generate an AI Snapshot to get a quick, structured summary of this paper.
Study Snapshot
ObjectiveStudy objective
MethodsResearch methodology
PopulationPopulation studied
Sample sizeSample sizes
OutcomesStudy outcomes here
ResultsStudy results comes here
LimitationsResearch study limitations comes here
A concise AI-generated summary of the paper will appear here once you click Generate AI Snapshot.
TL;DR
Performance ranking of 6 frequently used comorbidity scores was consistent across selected elderly populations and it is recommended that investigators use these performance data as one important factor when selecting a comorebidity score for epidemiologic analyses of health care utilization data.
Abstract
Performance ranking of 6 frequently used comorbidity scores was consistent across selected elderly populations. We recommend that investigators use these performance data as one important factor when selecting a comorbidity score for epidemiologic analyses of health care utilization data.
Keywords
Social SciencesMedicineEconomics, Econometrics and Finance
Journal of Chronic DiseasesA new method of classifying prognostic comorbidity in longitudinal studies: Development and validation
49,938 Citations1987Mary E. Charlson, Peter Pompei +2 more
The method of classifying comorbidity provides a simple, readily applicable and valid method of estimating risk of death fromComorbid disease for use in longitudinal studies and further work in larger populations is still required to refine the approach.
Journal of Clinical EpidemiologyAdapting a clinical comorbidity index for use with ICD-9-CM administrative databases
10,426 Citations1992Richard A. Deyo
It is concluded that the adapted comorbidity index will be useful in studies of disease outcome and resource use employing administrative databases.
Medical CareComorbidity Measures for Use with Administrative Data
9,920 Citations1998Anne Elixhauser, Claudia Steiner +2 more
The present method addresses some of the limitations of previous measures and produces an expanded set of comorbidities that easily is applied without further refinement to administrative data for a wide range of diseases.
CirculationPrediction of Coronary Heart Disease Using Risk Factor Categories
9,621 Citations1998Peter W.F. Wilson, Ralph B. D’Agostino +4 more
A simple coronary disease prediction algorithm was developed using categorical variables, which allows physicians to predict multivariate CHD risk in patients without overt CHD.
Journal of Clinical EpidemiologyA chronic disease score from automated pharmacy data
965 Citations1992Michael Von Korff, Edward H. Wagner +1 more
It is concluded that scoring automated pharmacy data can provide a stable measure of chronic disease status that, after controlling for health care utilization, is associated with physician-rated disease severity, patient-rated health status, and predicts subsequent mortality and hospitalization rates.
Journal of Clinical EpidemiologyPractical considerations on the use of the charlson comorbidity index with administrative data bases
898 Citations1996William D’Hoore, A. Bouckaert +1 more
It is concluded that the Charlson index may be an efficient approach to risk adjustment from administrative data bases, although it should be tested on other conditions.
American Journal of Public HealthThe accuracy of Medicare's hospital claims data: progress has been made, but problems remain.
717 Citations1992Elliot S. Fisher, Fredrick S. Whaley +5 more
Although some diagnoses and all major surgical procedures that were examined were accurately coded, the variability in the accuracy of diagnosis coding poses a problem that must be overcome if claims-based research is to achieve its full potential.
American Journal of EpidemiologyPerformance of Comorbidity Scores to Control for Confounding in Epidemiologic Studies using Claims Data
712 Citations2001Sebastian Schneeweiß
The authors compared the predictive performance of comorbidity scores for use in epidemiologic research with administrative databases and found that number of distinct medications used was the best predictor of future physician visits and a good predictor of mortality.
New England Journal of MedicineThe Treatment of Unrelated Disorders in Patients with Chronic Medical Diseases
638 Citations1998Donald A. Redelmeier, Siew Har Tan +1 more
In patients 65 or older who have chronic medical diseases and who receive prescription medications free of charge, unrelated disorders are undertreated and clinicians caring for patients with chronic diseases should remain alert to other disorders and minimize the number of missed opportunities for treating them.
Medical CareA Chronic Disease Score with Empirically Derived Weights
555 Citations1995Daniel O. Clark, Michael Von Korff +3 more
The results suggest that the revised chronic disease score and ambulatory care groups with empirically derived weights provide improved prediction of health care utilization and costs, as well as hospitalization and mortality, over age and sex alone.
Methods of Information in MedicineRisk Adjustment in Outcome Assessment: the Charlson Comorbidity Index
550 Citations1993C. Sicotte, Charles Tilquin +1 more
The Charlson Index is a useful approach to risk adjustment in outcomes research from administrative databases after being adapted to International Classification of Disease (ICD-9) codes.
JAMAComorbidities, complications, and coding bias. Does the number of diagnosis codes matter in predicting in-hospital mortality?
451 Citations1992Lisa I. Iezzoni
International Journal of EpidemiologyUse of comorbidity scores for control of confounding in studies using administrative databases
411 Citations2000Sebastian Schneeweiß, Malcolm Maclure
Comorbidity scores, particularly the CDS or D'Hoore's CI based on three-digit ICD-9 codes, may be useful in exploratory data analysis, however, residual confounding by comorbidities is inevitable, given how these scores are derived.
Measures of Association
367 Citations1983A.M. Liebetrau
Medical CareBias in the Coding of Hospital Discharge Data and Its Implications for Quality Assessment
354 Citations1994Patrick S. Romano, David Mark
Tions are underreported when patients die, for two possible reasons: coders identify all relevant diagnoses but the chronic codes are discarded when abstracts are truncated to
Health Services ResearchImproved Comorbidity Adjustment for Predicting Mortality in Medicare Populations
332 Citations2003Sebastian Schneeweiß, Philip S. Wang +2 more
In epidemiologic studies of the elderly, a modified diagnosis-based score using empirically derived weights provides improved adjustment for comorbidity and enhances the validity of findings.
Medical CareRecent Developments and Future Issues in the Use of Health Status Assessment Measures in Clinical Settings
252 Citations1992Sheldon Greenfield, Eugene C. Nelson
This paper provides a broad overview of the assessment of health status in clinical practice in three parts, highlighting the importance of interpreting change in health status has a central role.
Journal of Clinical EpidemiologySearching for an improved clinical comorbidity index for use with ICD-9-CM administrative data
243 Citations1996William A. Ghali, Ruth Hall +3 more
In this population, the ICD-9-CM adaptation used to create the Charlson score mattered little, but using study-specific weights with theCharlson variables substantially improved the power of these data to predict mortality.
Medical CareClinical Versus Administrative Data Bases for CABG Surgery
234 Citations1992Edward L. Hannan, Harold Kilburn +2 more
The results indicated that the clinical data base, the Cardiac Surgery Reporting System, is substantially better at predicting case-specific mortality than the administrative data system, the Statewide Planning and Research Cooperative System.
JAMAIdentifying Adults at Increased Risk of Coronary Disease
210 Citations1995Steven A. Grover
The ratio of total plasma cholesterol level to high-density lipoprotein cholesterol level is as accurate as current American screening guidelines, and future guidelines should better incorporate high- density cholesterol levels and nonlipid risk factors to target high-risk individuals accurately.
New England Journal of MedicineOutcomes of Reference Pricing for Angiotensin-Converting–Enzyme Inhibitors
181 Citations2002Sebastian Schneeweiß, Alexander M. Walker +4 more
It is found little evidence that when reference pricing for ACE inhibitors was introduced in British Columbia, patients stopped treatment for hypertension or that health care utilization and costs increased.
EpidemiologyParadoxical Relations of Drug Treatment with Mortality in Older Persons
180 Citations2001Robert J. Glynn, Eric L. Knight +2 more
Concerns are raised about using observational studies in high-risk populations to infer associations between drug use and outcomes after users of drugs from each of seven therapeutic classes had reduced age- and sex-adjusted rates of death relative to non-users.
Medical CareThe Performance of Different Lookback Periods and Sources of Information for Charlson Comorbidity Adjustment in Medicare Claims
166 Citations1999James Zhang, Theodore J. Iwashyna +1 more
Improvements in the prediction of mortality are obtained by incorporating alternative sources of data, and the widespread practice of comorbidity adjustment in pre-existing administrative data sources can be improved by taking more complete advantage of existing administrativeData sources.
Journal of Clinical EpidemiologySelecting a patient characteristics index for the prediction of medical outcomes using administrative claims data
137 Citations1995Catherine A. Melfi, E. Holleman +2 more
The Deyo-adapted Charlson Index performed least well of the four indices in the prediction of length of stay and 30-day mortality for patients undergoing total knee replacement surgery between 1985 and 1989, and the Relative Intensity Score and Patient and Severity Level result in the greatest improvement in measures of model fit.
PubMedAgreement between physicians' office records and Medicare Part B claims data.
132 Citations1995Fowles Jb, Lawthers Ag +4 more
This article tests agreement between demographic, diagnostic, and procedural information from primary-care physicians' office records and Medicare Part B claims for Maryland Medicare beneficiaries to determine the appropriate use of these data sources.
EpidemiologyCausation of Bias: The Episcope
129 Citations2001Malcolm Maclure, Sebastian Schneeweiß
For epidemiologists, this article serves as a review of ideas about confounding, information bias, and selection bias and underscores the need for routinely analyzing the sensitivity of study findings to multiple hypothesized biases.
PubMedImpact of reference-based pricing for angiotensin-converting enzyme inhibitors on drug utilization.
104 Citations2002Sebastian Schneeweiß, Stephen B. Soumerai +4 more
Reference-based pricing in British Columbia achieved a sustained reduction in drug expenditures, and no changes in overall use of antihypertensive therapy were observed, but further research is needed on the overall health and economic effects of such policies.
Medical CareThe Association Between Hospital Type and Mortality and Length of Stay
101 Citations2000Žhong Yuan, Gregory S. Cooper +3 more
As measured by the risk-adjusted 30-day mortality, TNFP hospitals had an overall better performance than other hospital types, perhaps reflecting the medical education and research activities found at teaching institutions.
Journal of Clinical EpidemiologyComparing clinical information with claims data: Some similarities and differences
98 Citations1991Leslíe L. Roos
Information on comorbidity obtained from hospital discharge abstracts for patients undergoing prostatectomy or cholecystectomy at a Winnipeg teaching hospital is compared with clinical data on preoperative medical conditions prospectively collected during an Anesthesia Follow-up study.
Journal of Clinical EpidemiologyRisk adjustment in claims-based research: The search for efficient approaches
89 Citations1989Leslíe L. Roos, Sandra M. Sharp +2 more
Claims-based indices of comorbidity and severity, as well as other measures derived from routinely collected administrative data, are developed and tested and difficulties in improving risk adjustment by more intensive data collection are discussed.
Journal of Clinical EpidemiologyStrategies for improving comorbidity measures based on Medicare and Medicaid claims data
80 Citations2000Philip S. Wang, Alexander M. Walker +4 more
Even simpler measures of comorbidity (crude number of diagnoses) and of prior health care utilization (total days spent in the hospital) performed at least as well in predicting mortality as did the more complex index scores which assigned points and weights for specific conditions.
Medical Decision MakingApplication of Treatment Thresholds to Diagnostic-test Evaluation
63 Citations1997Karel G.M. Moons, Theo Stijnen +5 more
It is shown that comparison of diagnostic tests using the areas under the ROC curves may lead to erroneous conclusions about therapeutic usefulness, and it would be more appropriate to also consider the clinical consequences in evaluating diagnostic tests.
PubMedTrends and determinants of prescription drug expenditures in the elderly: data from the British Columbia Pharmacare Program.
61 Citations1993Anderson Gm, Kerluke Kj +3 more
The analysis indicates that 61.5% of new drug expenditures can be attributed to four specific drugs and that the relative importance of price and utilization rates in determining changes in expenditures on old drugs varies by drug category.
Journal of Clinical EpidemiologyAging, Comorbidity, and Reduced Rates of Drug Treatment for Diabetes Mellitus
57 Citations1999Robert J. Glynn, Mark Monane +3 more
Although the prevalence of diabetes increases with age and the risks of many consequences of diabetes remain high, the rate of drug treatment for diabetes declines with older age and greater comorbidity, perhaps because of concern about side effects or reduced treatment benefits due to competing risks of death.
PubMedControlling for confounding by indication for treatment. Are administrative data equivalent to clinical data?
50 Citations1995Roy M. Poses, Wally R. Smith +2 more
It is concluded that nonrandomized, observational outcome studies that fail to control for prognostic differences between patients receiving different treatments may not always be valid.
American Journal of EpidemiologyAgreement between Drug Treatment Data and a Discharge Diagnosis of Diabetes Mellitus in the Elderly
44 Citations1999RJ Glynn, Mark Monane +3 more
These paradoxical associations with mortality and the lower agreement between discharge diagnoses and drug treatments associated with older age, nursing home residence, and comorbidity suggest limitations in the use of claims data to identify diabetes in the elderly.