Developing a Claim-based Version of the ACE-27 Comorbidity Index

OBJECTIVES: The adult comorbidity evaluation (ACE-27) is a medical record-based comorbidity index that predicts survival among various types of cancer patients. The purpose of this study was to compare the medical record-based ACE-27 instrument to a newly developed administrative claim-based ACE-27 measure. STUDY DESIGN AND SETTING: Cross-sectional study of 4,300 breast and prostate cancer patients from the Centers for Disease Control and Prevention Patterns of Care Study. RESULTS: Comorbidities with the highest concordance were diabetes (sensitivity=84.6%, κ=0.58 for breast cancer patients; sensitivity=0.764, κ=0.54 for prostate cancer patients), and hypertension (sensitivity=78.5%, κ=0.32 for breast cancer patients; sensitivity=69.6%, κ=0.28 for prostate cancer patients). Diseases with fair or moderate agreement in one or both cancer sites include congestive heart failure, arrhythmia, hypertension, respiratory diseases, hepatic disease, renal disease, dementia, and neuromuscular disease. For overall indices, agreement was fair but with high sensitivities in the collapsed indices, and the highest sensitivities in the lowest level of decompensation. CONCLUSIONS: The ACE-27 comorbidity score derived from administrative claims data provides a tool to examine the relationship between comorbidity, cancer diagnosis, and outcomes in future epidemiologic research, particularly when medical record review is logistically impossible. The classification of most comorbidities into 2 or 3 levels of severity within a claim-based measure is a major development. Future research should be directed toward refining the measure with a longer review period or different paradigms for diagnosis identification, and testing the predictive ability of the measure in terms of survival, complications, or other outcomes of care

Breast cancer · Cancer · Cancer registry · Comorbidity · Concordance · Diabetes mellitus · Disease · Intensive care medicine · Physical therapy · Prostate cancer · Cancer survivorship and care · Chronic Disease Management Strategies · Frailty in Older Adults · Internal Medicine · Medicine

• Examination of individual and multiple comorbid conditions and health-related quality of life in older cancer survivors

  Open Access•Elizabeth J Siembida, Ashley Wilder Smith et al.•Quality of Life Research•2021

  Incluir item

• Receipt of Regular Primary Care and Early Cancer Detection in Appalachia

  Open Access•Fabian Camacho, Wenke Hwang et al.•The Journal of Rural Health•2015

  Incluir item

• Disparities in Colorectal Cancer Treatment Delay Within Appalachia—The Role of For‐Profit Hospitals

  Open Access•Eric E Seiber, Fabian Camacho et al.•The Journal of Rural Health•2015

  Incluir item

• Patterns of Care for Metastatic Colorectal Cancer in Appalachia, and the Clinical, Sociodemographic, and Service Provider Determinants

  Open Access•Steven T Fleming, Heath B Mackley et al.•The Journal of Rural Health•2016

  Incluir item

• Clinical, Sociodemographic, and Service Provider Determinants of Guideline Concordant Colorectal Cancer Care for Appalachian Residents

  Open Access•Steven T Fleming, Heath B Mackley et al.•The Journal of Rural Health•2014

  Incluir item

• The Relative Ability of Comorbidity Ascertainment Methodologies to Predict In-Hospital Mortality Among Hospitalized Community-acquired Pneumonia Patients

  Ronald E Weir, Christopher S Lyttle et al.•Medical Care•2018

  Incluir item

• Development of a comorbidity index using physician claims data

  Open Access•Carrie N Klabunde, Arnold L Potosky et al.•Journal of Clinical Epidemiology•2000

  Incluir item

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

  Open Access•Richard A Deyo, R DEYO•Journal of Clinical Epidemiology•1992

  Incluir item

• How to measure comorbiditya critical review of available methods

  Open Access•Joseph M Kirman, V DEGROOT et al.•Journal of Clinical Epidemiology•2003

  Incluir item

• A new method of classifying prognostic comorbidity in longitudinal studies

  Open Access•Mary E Charlson, Peter Pompei et al.•Journal of Chronic Diseases•1987

  Incluir item

• Underutilization of Mammography in Older Breast Cancer Survivors

  Marilyn M Schapira, Timothy L Mcauliffe et al.•Medical Care•2000

  Incluir item

• Data Sources for Measuring Comorbidity

  Carrie N Klabunde, Linda C Harlan et al.•Medical Care•2006

  Incluir item

• Comorbidity as a Predictor of Stage of Illness for Patients With Breast Cancer

  Steven T Fleming, Holly G Pursley et al.•Medical Care•2005

  Incluir item

• Comorbidity Measures for Use with Administrative Data

  Anne Elixhauser, Claudia Steiner et al.•Medical Care•1998

  Incluir item

• Comorbidity Indices to Predict Mortality From Medicare Data

  Yan Yan, Elena Birman???Deych et al.•Medical Care•2005

  Incluir item

• A Comprehensive Prognostic Index to Predict Survival Based on Multiple Comorbidities

  Steven T Fleming, Amita Rastogi et al.•Medical Care•1999

  Incluir item