Identifying Increased Risk of Readmission and In-hospital Mortality Using Hospital Administrative Data

共病 置信区间 医学 统计的 优势比 协变量 逻辑回归 索引(排版) 可能性 急诊医学 统计 人口学 内科学 万维网 社会学 数学 计算机科学
作者
Brian J. Moore,Susan V. White,Raynard Washington,Natalia Coenen,Anne Elixhauser
出处
期刊:Medical Care [Lippincott Williams & Wilkins]
卷期号:55 (7): 698-705 被引量:658
标识
DOI:10.1097/mlr.0000000000000735
摘要

We extend the literature on comorbidity measurement by developing 2 indices, based on the Elixhauser Comorbidity measures, designed to predict 2 frequently reported health outcomes: in-hospital mortality and 30-day readmission in administrative data. The Elixhauser measures are commonly used in research as an adjustment factor to control for severity of illness.We used a large analysis file built from all-payer hospital administrative data in the Healthcare Cost and Utilization Project State Inpatient Databases from 18 states in 2011 and 2012.The final models were derived with bootstrapped replications of backward stepwise logistic regressions on each outcome. Odds ratios and index weights were generated for each Elixhauser comorbidity to create a single index score per record for mortality and readmissions. Model validation was conducted with c-statistics.Our index scores performed as well as using all 29 Elixhauser comorbidity variables separately. The c-statistic for our index scores without inclusion of other covariates was 0.777 (95% confidence interval, 0.776-0.778) for the mortality index and 0.634 (95% confidence interval, 0.633-0.634) for the readmissions index. The indices were stable across multiple subsamples defined by demographic characteristics or clinical condition. The addition of other commonly used covariates (age, sex, expected payer) improved discrimination modestly.These indices are effective methods to incorporate the influence of comorbid conditions in models designed to assess the risk of in-hospital mortality and readmission using administrative data with limited clinical information, especially when small samples sizes are an issue.
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