Objectives.This study attempts to develop a comprehensive set of comorbidity measures for use with large administrative inpatient datasets.Methods.The study involved clinical and empirical review of comorbidity measures, development of a framework that attempts to segregate comorbidities from other

https://czresearch.com/dropbox/Elixhauser_MedCare_1998v36p8.pdf

Comorbidity measures for use with administrative data.

Objectives:Implementation of the International Statistical Classification of Disease and Related Health Problems, 10th Revision (ICD-10) coding system presents challenges for using administrative data. Recognizing this, we conducted a multistep process to develop ICD-10 coding algorithms to define C

https://czresearch.com/dropbox/Quan_MedCare_2005v43p1130.pdf

Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data.

With advances in the effectiveness of treatment and disease management, the contribution of chronic comorbid diseases (comorbidities) found within the Charlson comorbidity index to mortality is likely to have changed since development of the index in 1984. The authors reevaluated the Charlson index and reassigned weights to each condition by identifying and following patients to observe mortality within 1 year after hospital discharge. They applied the updated index and weights to hospital discharge data from 6 countries and tested for their ability to predict in-hospital mortality. Compared with the original Charlson weights, weights generated from the Calgary, Alberta, Canada, data (2004) were 0 for 5 comorbidities, decreased for 3 comorbidities, increased for 4 comorbidities, and did not change for 5 comorbidities. The C statistics for discriminating in-hospital mortality between the new score generated from the 12 comorbidities and the Charlson score were 0.825 (new) and 0.808 (old), respectively, in Australian data (2008), 0.828 and 0.825 in Canadian data (2008), 0.878 and 0.882 in French data (2004), 0.727 and 0.723 in Japanese data (2008), 0.831 and 0.836 in New Zealand data (2008), and 0.869 and 0.876 in Swiss data (2008). The updated index of 12 comorbidities showed good-to-excellent discrimination in predicting in-hospital mortality in data from 6 countries and may be more appropriate for use with more recent administrative data.

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Updating and Validating the Charlson Comorbidity Index and Score for Risk Adjustment in Hospital Discharge Abstracts Using Data From 6 Countries

The mission of the Agency for Healthcare Research and Quality is “to improve the quality, safety, efficiency, and effectiveness of health care for all Americans”. The organization and selected major activities of the Agency are briefly described.

The Agency for Healthcare Research and Quality

Background Incidence estimates of hospitalizations for community-acquired pneumonia among children in the United States that are based on prospective data collection are limited. Updated estimates of pneumonia that has been confirmed radiographically and with the use of current laboratory diagnostic tests are needed. Methods We conducted active population-based surveillance for community-acquired pneumonia requiring hospitalization among children younger than 18 years of age in three hospitals in Memphis, Nashville, and Salt Lake City. We excluded children with recent hospitalization or severe immunosuppression. Blood and respiratory specimens were systematically collected for pathogen detection with the use of multiple methods. Chest radiographs were reviewed independently by study radiologists. Results From January 2010 through June 2012, we enrolled 2638 of 3803 eligible children (69%), 2358 of whom (89%) had radiographic evidence of pneumonia. The median age of the children was 2 years (interquartile ...

/pdf/community-acquired-pneumonia-requiring-hospitalization-among-3mq4tz7uab.pdf

Community-acquired pneumonia requiring hospitalization among U.S. adults

Context Published rates of health care utilization and rehospitalization by people with sickle cell disease have had limited generalizability and are not population based. Objective To provide benchmark data for rates of acute care utilization and rehospitalizations for patients with sickle cell disease. Design Retrospective cohort of sickle cell disease–related emergency department (ED) visits and hospitalizations from select states in the 2005 and 2006 Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases and State Emergency Department Databases. Setting Eight geographically dispersed states (Arizona, California, Florida, Massachusetts, Missouri, New York, South Carolina, and Tennessee) that provide encrypted identifiers and have sufficient numbers of patients with sickle cell disease; together these states have 33% of the US population with sickle cell disease. Patients A total of 21 112 patients with sickle cell–related treat-and-release ED visits or inpatient hospitalizations. Main Outcome Measures Rates of acute care utilization and rehospitalizations. Population-based utilization rates were also calculated. Results The 21 112 people with sickle cell disease had 109 344 encounters, a mean of 2.59 (95% confidence interval [CI], 2.53-2.65) encounters per patient per year, 1.52 (95% CI, 1.48-1.55) encounters for hospitalizations and 1.08 (95% CI, 1.04-1.11) for treat-and-release ED visits. Utilization was highest for 18- to 30-year-olds, 3.61 (95% CI, 3.47-3.75) encounters per patient per year, and those with public insurance, 3.22 (95% CI, 3.13-3.31) encounters per patient per year. Publicly insured 18- to 30-year-olds had 4.80 (95% CI, 4.58-5.02) encounters per patient per year. Approximately 29% of the population had no encounters while 16.9% had 3 or more encounters per year. The 30-day and 14-day rehospitalization rates were 33.4% (95% CI, 33.0%-33.8%) and 22.1% (95% CI, 21.8%-22.4%), respectively. The rehospitalization rate was highest for 18- to 30-year-olds, with 41.1% (95% CI, 40.5%-41.7%) rehospitalized within 30 days and 28.4% (95% CI, 27.8%-29.0%) within 14 days. Rehospitalizations were also highest for publicly insured patients. Conclusion Among patients with sickle cell disease, acute care encounters and rehospitalizations were frequent, particularly for 18- to 30-year-olds.

https://jamanetwork.com/journals/jama/articlepdf/185633/joc05031_1288_1294.pdf

Acute Care Utilization and Rehospitalizations for Sickle Cell Disease

Background Since 1989, laparoscopic cholecystectomy has been widely adopted as a treatment for gallstone disease. We analyzed the association between the introduction of this procedure and three variables: the rate at which cholecystectomy was performed in Maryland, the characteristics of patients undergoing cholecystectomy in routine clinical practice, and operative mortality. Methods and Results We used 1985-1992 hospital-discharge data from all 54 acute care hospitals in Maryland to identify open and laparoscopic cholecystectomies, characteristics of patients undergoing these procedures, and deaths occurring during hospitalizations in which these procedures were performed. The annual rate of cholecystectomy, adjusted for age, rose from 1.69 per 1000 state residents in 1987-1989 to 2.17 per 1000 residents in 1992, an increase of 28 percent (P<0.001). As compared with patients undergoing open cholecystectomy, patients undergoing laparoscopic cholecystectomy tended to be younger, less likely to have acute...

Surgical Rates and Operative Mortality for Open and Laparoscopic Cholecystectomy in Maryland

Health care reform has pinpointed hospital readmissions as a key area for improving care coordination and achieving potential savings. Stakeholders are using data to devise strategies to reduce readmissions. Two criteria for evaluating potential areas of impact include volume and costs. For example, the Centers for Medicare & Medicaid Services (CMS) Hospital Readmissions Reduction Program has selected acute myocardial infarction, heart failure, and pneumonia as target areas for the Medicare population. CMS chose these conditions, in part, because of their high prevalence and their associated high costs for total admissions and readmissions among Medicare beneficiaries. In 2015, CMS will expand their assessment of readmissions to additional conditions that represent high volume and costs.Identifying conditions that contribute the most to the total number of readmissions and related costs for all payers may aid health care stakeholders in deciding which conditions to target to maximize quality improvement and cost-reduction efforts. This Statistical Brief uses readmissions data from the Healthcare Cost and Utilization Project (HCUP) to present the conditions with the largest number of 30-day all-cause readmissions among U.S. hospitals in 2011 and their associated costs. We limited the study population to Medicare beneficiaries aged 65 years and older and to individuals aged 18–64 years who were privately insured, uninsured, or covered by Medicaid. We display the 10 conditions with the largest number of readmissions for each payer.

Conditions With the Largest Number of Adult Hospital Readmissions by Payer, 2011

Objective:Bariatric surgery is one of the fastest growing hospital procedures. Our objective is to examine the safety outcomes and utilization of resources in the 6 months after bariatric surgery using a nationwide, population-based sample.Data/Design:We examine insurance claims for 2522 bariatric s

Claudia A Steiner

Papers

Comorbidity measures for use with administrative data.

Acute Care Utilization and Rehospitalizations for Sickle Cell Disease

Surgical Rates and Operative Mortality for Open and Laparoscopic Cholecystectomy in Maryland

Conditions With the Largest Number of Adult Hospital Readmissions by Payer, 2011

Healthcare utilization and outcomes after bariatric surgery.