Evaluation of co-morbidity indices in patients admitted for Chronic Obstructive Pulmonary Disease

Developing a claim-based version of the ACE-27 comorbidity index: a comparison with medical record review

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.

In a retrospective study of chronic obstructive pulmonary disease inpatients, respiratory comorbidities were significantly associated with prognosis

BACKGROUND AND OBJECTIVE

Comorbidities may be related to the prognosis for chronic obstructive pulmonary disease (COPD). We examined respiratory comorbidities associated with length of stay and in-hospital mortality among COPD patients.

METHODS

We used the Hospital Person Oriented Information (HPOI) database of Statistics Canada for a 5-year period. Over 4 years (fiscal years 1994-1995 to 1998-1999), 143,135 records listed COPD as the most responsible diagnosis for men and 122,065 records for women aged 40 years or more, and 75,780 men and 69,539 women were admitted to hospital at least once. Logistic regression modeling was used to examine the relationships between respiratory comorbidities and hospital outcomes adjusting for covariates.

RESULTS

Of the COPD patients, 10% had pneumonia-influenza and 3% had asthma as comorbid conditions. Women had a higher prevalence of asthma than men. The median length of stay at hospital was approximately 7 days, and 95% of patients were discharged alive. The odds ratio (95% confidence interval) for pneumonia-influenza in relation to in-hospital death was 3.56 (3.31, 3.83) for men and 3.29 (3.00, 3.61) for women. For comorbid asthma the corresponding odds ratios were 0.56 (0.36, 0.61) and 0.54 (0.35, 0.57), respectively.

CONCLUSIONS

COPD inpatients with pneumonia-influenza had a worse prognosis and those with asthma had a better prognosis.