Beyond Comorbidity
Expanding the Definition and Measurement of Complexity Among Older Adults Using Administrative Claims Data
Bibliographic Data
| ID | 9100558 |
|---|---|
| Authors | Elizabeth A Chrischilles (0000-0002-1843-1955, University of Iowa, corresponding author), Elizabeth Chrischilles, Kathleen Schneider (0000-0002-0108-1725, General Dynamics (United States)), June Wilwert, June M Wilwert (General Dynamics (United States)), Gregory Lessman (General Dynamics (United States)), Brian O’donnell (0000-0001-6085-6327, General Dynamics (United States)), Brian Gryzlak (0000-0002-0928-2943, University of Iowa, corresponding author), Kara Wright (University of Iowa, corresponding author), Robert Wallace (0000-0001-7411-6338), Robert B Wallace (0000-0001-6040-3803, University of Iowa, corresponding author) |
| Year | 2014 |
| Volume | 52 |
| Issue | Supplement 2 |
| Pages | S75-S84 |
| Publication date | 2014-03-01 |
| Open Access | No |
| Type | ARTICLE |
| Venue | Medical Care (JOURNAL) |
| Journal identifiers | ISSN: 0025-7079 • E-ISSN: 1537-1948 |
| Publisher | Ovid Technologies (Wolters Kluwer Health) (PUBLISHER) |
| DOI | 10.1097/mlr.0000000000000026 |
| PMID | 24561763 |
| OpenAlex | W2069612116 |
| Language | EN |
| Citations received | 4 |
| References cited | 3 |
BACKGROUND: Studies of patients with multiple chronic conditions using claims data are often missing important determinants of treatments and outcomes, such as function status and disease severity. We sought to identify and evaluate a class of function-related indicators (FRIs) from administrative claims data. POPULATION: The study cohort comprised US Medicare beneficiaries aged 65 years or older with Parts A and B fee-for-service and Part D coverage, with a hospitalization for acute myocardial infarction during 2007. METHODS: Measures during the year before admission included the FRIs, demographics, conventional comorbidity measures, and prior hospitalization. Outcomes were receipt of cardiac catheterization during the index hospitalization and 12-month mortality. Model development used a random sample (n=72,056) with an equal sample for validation. RESULTS: In addition to prior cardiovascular conditions (85%), 40% had ≥1 comorbid condition, 30% were hospitalized in the prior 6 months, and 65% had ≥1 FRI [eg, delirium/dementia (22.7%), depression (16.7%), mobility limitation (16.1%), and chronic skin ulcers (12.6%)]. Including the FRIs improved mortality and cardiac catheterization prediction models (C-statistics 0.71 and 0.77, respectively). Patients with more cardiovascular conditions received less cardiac catheterization [minimally adjusted odds ratio (OR) 0.83; 95% confidence interval (CI), 0.82-0.83], as did patients with more comorbidities (minimally adjusted OR 0.70; 95% CI, 0.69-0.71), but this was attenuated by adjusting for functional status (fully adjusted OR for cardiovascular conditions 0.95; 95% CI, 0.94-0.96 and for comorbid conditions 0.94; 95% CI, 0.92-0.95). CONCLUSIONS: Claims data studies that include indicators of potentially diminished patient functional status better capture heterogeneity of patients with multiple chronic conditions
Cardiac catheterization · Comorbidity · Confidence interval · Depression (economics) · Geriatrics · Myocardial infarction · Odds ratio · Physical therapy · Population · Psychiatry · Chronic Disease Management Strategies · Emergency Medicine · Frailty in Older Adults · Health Systems, Economic Evaluations, Quality of Life · Internal Medicine · Medicine
Comparing Survey-Based Frailty Assessment to Medicare Claims in Predicting Health Outcomes and Utilization in Medicare Beneficiaries
Approach to Multimorbidity Burden Classification and Outcomes in Older Adults With Heart Failure
Comparison of Medicare Claims-based Proxy Measures of Poor Function and Associations With Treatment Receipt and Mortality in Older Colon Cancer Patients
Measuring Multimorbidity
| Citations per year | 0.57 |
|---|---|
| Citation span | 2019 - 2023 (5) |
| Highly cited | No |