A New Casemix Adjustment Index for Hospital Mortality Among Patients With Congestive Heart Failure

Bibliographic Data

ID9099672
AuthorsCarisi A Polanczyk (0000-0002-2447-2577, Massachusetts General Hospital, corresponding author), Luís Eduardo Paim Rohde (0000-0002-6557-393X), Edward A Philbin, Thomas G Di Salvo (0000-0003-2056-9336)
Year1998
Volume36
Issue10
Pages1489-1499
Publication date1998-10-01
Open AccessNo
TypeARTICLE
VenueMedical Care (JOURNAL)
Journal identifiersISSN: 0025-7079 • E-ISSN: 1537-1948
PublisherOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/00005650-199810000-00007
PMID9794342
OpenAlexW1966503041
LanguageEN
Citations received4
References cited38

OBJECTIVES: Comparative analysis of hospital outcomes requires reliable adjustment for casemix. Although congestive heart failure is one of the most common indications for hospitalization, congestive heart failure casemix adjustment has not been widely studied. The purposes of this study were (1) to describe and validate a new congestive heart failure-specific casemix adjustment index to predict in-hospital mortality and (2) to compare its performance to the Charlson comorbidity index. METHODS: Data from all 4,608 admissions to the Massachusetts General Hospital from January 1990 to July 1996 with a principal ICD-9-CM discharge diagnosis of congestive heart failure were evaluated. Massachusetts General Hospital patients were randomly divided in a derivation and a validation set. By logistic regression, odds ratios for in-hospital death were computed and weights were assigned to construct a new predictive index in the derivation set. The performance of the index was tested in an internal Massachusetts General Hospital validation set and in a non-Massachusetts General Hospital external validation set incorporating data from all 1995 New York state hospital discharges with a primary discharge diagnosis of congestive heart failure. RESULTS: Overall in-hospital mortality was 6.4%. Based on the new index, patients were assigned to six categories with incrementally increasing hospital mortality rates ranging from 0.5% to 31%. By logistic regression, "c" statistics of the congestive heart failure-specific index (0.83 and 0.78, derivation and validation set) were significantly superior to the Charlson index (0.66). Similar incrementally increasing hospital mortality rates were observed in the New York database with the congestive heart failure-specific index ("c" statistics 0.75). CONCLUSION: In an administrative database, this congestive heart failure-specific index may be a more adequate casemix adjustment tool to predict hospital mortality in patients hospitalized for congestive heart failure

Cardiology · Comorbidity · Heart failure · Index (typography) · Intensive care medicine · Logistic regression · Odds · Odds ratio · Cardiovascular Function and Risk Factors · Emergency Medicine · Heart Failure Treatment and Management · Internal Medicine · Medicine · Sepsis Diagnosis and Treatment

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