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Comorbidity and thirty-day hospital readmission odds in chronic obstructive pulmonary disease: a comparison of the Charlson and Elixhauser comorbidity indices.

ABSTRACT: BACKGROUND:Readmissions following exacerbations of chronic obstructive pulmonary disease (COPD) are prevalent and costly. Multimorbidity is common in COPD and understanding how comorbidity influences readmission risk will enable health systems to manage these complex patients. OBJECTIVES:We compared two commonly used comorbidity indices published by Charlson and Elixhauser regarding their ability to estimate readmission odds in COPD and determine which one provided a superior model. METHODS:We analyzed discharge records for COPD from the Nationwide Readmissions Database spanning 2010 to 2016. Inclusion and readmission criteria from the Hospital Readmissions Reduction Program were utilized. Elixhauser and Charlson Comorbidity Index scores were calculated from published methodology. A mixed-effects logistic regression model with random intercepts for hospital clusters was fit for each comorbidity index, including year, patient-level, and hospital-level covariates to estimate odds of thirty-day readmissions. Sensitivity analyses included testing age inclusion thresholds and model stability across time. RESULTS:In analysis of 1.6 million COPD discharges, readmission odds increased by 9% for each half standard deviation increase of Charlson Index scores and 13% per half standard deviation increase of Elixhauser Index scores. Model fit was slightly better for the Elixhauser Index using information criteria. Model parameters were stable in our sensitivity analyses. CONCLUSIONS:Both comorbidity indices provide meaningful information in prediction readmission odds in COPD with slightly better model fit in the Elixhauser model. Incorporation of comorbidity information into risk prediction models and hospital discharge planning may be informative to mitigate readmissions.

SUBMITTER: Buhr RG

PROVIDER: S-EPMC6794890 | biostudies-other | 2019 Oct

REPOSITORIES: biostudies-other

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Comorbidity and thirty-day hospital readmission odds in chronic obstructive pulmonary disease: a comparison of the Charlson and Elixhauser comorbidity indices.

Buhr Russell G RG Jackson Nicholas J NJ Kominski Gerald F GF Dubinett Steven M SM Ong Michael K MK Mangione Carol M CM

BMC health services research 20191015 1

<h4>Background</h4>Readmissions following exacerbations of chronic obstructive pulmonary disease (COPD) are prevalent and costly. Multimorbidity is common in COPD and understanding how comorbidity influences readmission risk will enable health systems to manage these complex patients.<h4>Objectives</h4>We compared two commonly used comorbidity indices published by Charlson and Elixhauser regarding their ability to estimate readmission odds in COPD and determine which one provided a superior mode ...[more]

PMID: 31615508

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Project description:The Centers for Medicare & Medicaid Services recently identified 30-day readmission after discharge from inpatient rehabilitation facilities as a national quality indicator. Research is needed to determine the rates and factors related to readmission in this patient population.To determine 30-day readmission rates and factors related to readmission for patients receiving postacute inpatient rehabilitation.Retrospective cohort study of records for 736,536 Medicare fee-for-service beneficiaries (mean age, 78.0 [SD, 7.3] years) discharged from 1365 inpatient rehabilitation facilities to the community in 2006 through 2011. Sixty-three percent of patients were women, and 85.1% were non-Hispanic white.Thirty-day readmission rates for the 6 largest diagnostic impairment categories receiving inpatient rehabilitation. These included stroke, lower extremity fracture, lower extremity joint replacement, debility, neurologic disorders, and brain dysfunction.Mean rehabilitation length of stay was 12.4 (SD, 5.3) days. The overall 30-day readmission rate was 11.8% (95% CI, 11.7%-11.8%). Rates ranged from 5.8% (95% CI, 5.8%-5.9%) for patients with lower extremity joint replacement to 18.8% (95% CI, 18.8%-18.9%). for patients with debility. Rates were highest in men (13.0% [ 95% CI, 12.8%-13.1%], vs 11.0% [95% CI, 11.0%-11.1%] in women), non-Hispanic blacks (13.8% [95% CI, 13.5%-14.1%], vs 11.5% [95% CI, 11.5%-11.6%] in whites, 12.5% [95% CI, 12.1%-12.8%] in Hispanics, and 11.9% [95% CI, 11.4%-12.4%] in other races/ethnicities), beneficiaries with dual eligibility (15.1% [95% CI, 14.9%-15.4%], vs 11.1% [95% CI, 11.0%-11.2%] for no dual eligibility), and in patients with tier 1 comorbidities (25.6% [95% CI, 24.9%-26.3%], vs 18.9% [95% CI, 18.5%-19.3%] for tier 2, 15.1% [95% CI, 14.9%-15.3%] for tier 3, and 9.9% [95% CI, 9.9%-10.0%] for no tier comorbidities). Higher motor and cognitive functional status were associated with lower hospital readmission rates across the 6 impairment categories. Adjusted readmission rates by state ranged from 9.2% to 13.6%. Approximately 50% of patients rehospitalized within the 30-day period were readmitted within 11 days of discharge. Medicare Severity Diagnosis-Related Group codes for heart failure, urinary tract infection, pneumonia, septicemia, nutritional and metabolic disorders, esophagitis, gastroenteritis, and digestive disorders were common reasons for readmission.Among postacute rehabilitation facilities providing services to Medicare fee-for-service beneficiaries, 30-day readmission rates ranged from 5.8% to 18.8% for selected impairment groups. Further research is needed to understand the causes of readmission.

Project description:Examining health care system characteristics possibly associated with 30-day readmission may reveal opportunities to improve healthcare quality as well as reduce costs.Examine the relationship between 30-day mental health readmission for persons with schizophrenia and county-level community treatment characteristics.Observational study of 18 state Medicaid programs (N=274 counties, representing 103,967 enrollees with schizophrenia 28,083 of whom received more than 1 mental health hospitalization) using Medicaid administrative and United States Area Health Resource File data from 2005. Medicaid is a federal-state program and major health insurance provider for low income and disabled individuals, and the predominant provider of insurance for individuals with schizophrenia. The Area Health Resource File provides county-level estimates of providers. We first fit a regression model examining the relationship between 30-day mental health readmission and enrollee characteristics (e.g., demographics, substance use disorder [SUD], and general medical comorbidity) from which we created a county-level demographic and comorbidity case-mix adjuster. The case-mix adjuster was included in a second regression model examining the relationship between 30-day readmission and county-level factors: (i) quality (antipsychotic/visit continuity, post-hospital follow-up); (ii) mental health hospitalization (length of stay, admission rates); and (iii) treatment capacity (e.g., population-based estimates of outpatient providers/clinics). We calculated predicted probabilities of readmission for significant patient and county-level variables.Higher county rates of mental health visits within 7-days post-hospitalization were associated with lower readmission probabilities (e.g., county rates of 7-day follow up of 55% versus 85%, readmission predicted probability (PP) [95%CI]=16.1% [15.8%-16.4%] versus 13.3% [12.9%-13.6%]). In contrast, higher county rates of mental health hospitalization were associated with higher readmission probabilities (e.g., country admission rates 10% versus 30%, readmission predicted probability=11.3% [11.0%-11.6%] versus 16.7% [16.4%-17.0%]). Although not our primary focus, enrollee comorbidity was associated with higher predicted probability of 30-day mental health readmission: PP [95%CI] for enrollees with SUD=23.9% [21.5%-26.3%] versus 14.7% [13.9%-15.4%] for those without; PP [95% CI] for those with=three chronic medical conditions=25.1% [22.1%-28.2%] versus none=17.7% [16.3%-19.1].County rates of hospitalization and 7-day follow-up post hospital discharge were associated with readmission, along with patient SUD and general medical comorbidity. This observational design limits causal inference and utilization patterns may have changed since 2005. However, overall funding for U.S. Medicaid programs remained constant since 2005, reducing the likelihood significant changes. Last, our inability to identify community capacity variables associated with readmission may reflect imprecision of some variables as measured in the Area Health Resource File. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE AND FOR HEALTH POLICIES: Healthcare policy and programming to reduce 30-day mental health readmissions should focus on county-level factors that contribute to hospitalization in general and improving transitions to community care, as well as patient comorbidity.Given the likely importance of local care systems, to reduce readmission future research is needed to refine community-level capacity variables that are associated with reduced readmissions; and to evaluate models of care coordination in this population.

Project description:BackgroundUnderstanding how comorbidity measures contribute to patient mortality is essential both to describe patient health status and to adjust for risks and potential confounding. The Charlson and Elixhauser comorbidity indices are well-established for risk adjustment and mortality prediction. Still, a different set of comorbidity weights might improve the prediction of in-hospital mortality. The present study, therefore, aimed to derive a set of new Swiss Elixhauser comorbidity weightings, to validate and compare them against those of the Charlson and Elixhauser-based van Walraven weights in an adult in-patient population-based cohort of general hospitals.MethodsRetrospective analysis was conducted with routine data of 102 Swiss general hospitals (2012-2017) for 6.09 million inpatient cases. To derive the Swiss weightings for the Elixhauser comorbidity index, we randomly halved the inpatient data and validated the results of part 1 alongside the established weighting systems in part 2, to predict in-hospital mortality. Charlson and van Walraven weights were applied to Charlson and Elixhauser comorbidity indices. Derivation and validation of weightings were conducted with generalized additive models adjusted for age, gender and hospital types.ResultsOverall, the Elixhauser indices, c-statistic with Swiss weights (0.867, 95% CI, 0.865-0.868) and van Walraven's weights (0.863, 95% CI, 0.862-0.864) had substantial advantage over Charlson's weights (0.850, 95% CI, 0.849-0.851) and in the derivation and validation groups. The net reclassification improvement of new Swiss weights improved the predictive performance by 1.6% on the Elixhauser-van Walraven and 4.9% on the Charlson weights.ConclusionsAll weightings confirmed previous results with the national dataset. The new Swiss weightings model improved slightly the prediction of in-hospital mortality in Swiss hospitals. The newly derive weights support patient population-based analysis of in-hospital mortality and seek country or specific cohort-based weightings.

Project description:BackgroundResearch on age-related complications secondary to shunts in normal pressure hydrocephalus (NPH) is primarily limited to single-center studies and small cohorts.ObjectiveTo determine the rates of hospital readmission and surgical complications, and factors that predict them, following shunt surgery for NPH in a large healthcare network.MethodsSurgical procedures, complications, and readmissions for adults undergoing ventricular shunting for NPH were determined using de-identified claims from a privately insured United States healthcare network in years 2007-2014. Univariate and multivariate statistics were used to determine factors that predict poor surgical outcomes. The primary outcome variable was surgical complications or readmissions (composite variable for any major perioperative complication or 30-d readmission).ResultsThe 30-d readmission rate for 974 patients with NPH who underwent ventricular shunting was 7.29%; the most common reasons for readmission were shunt-related complications, infection, hemorrhage, altered mental status, and cardiopulmonary and musculoskeletal problems. The perioperative complication rate was 21.15%, including intraparenchymal hemorrhage (5.85%) and extra-axial (subdural or epidural) hematoma (5.54%). The overall rate of having a surgical complication or 30-d readmission was 25.15%. Age did not predict surgical complication or 30-d readmission. Preoperative comorbidities independently associated with poor outcome were myocardial infarction within 1 yr (OR = 3.984, 95% CI = 1.105-14.368); existing cerebrovascular disease (odds ratio [OR] = 2.206, 95% CI = 1.544-3.152); and moderate/severe renal disease (OR = 2.000, 95% CI = 1.155-3.464).ConclusionThe rate of complications or readmission within 30 d of ventricular shunting for NPH is 25.15%. Preoperative comorbidities of myocardial infarction within 1 yr, cerebrovascular disease, and moderate/severe renal disease are independent risk factors for poor outcome.

Dataset Information

Comorbidity and thirty-day hospital readmission odds in chronic obstructive pulmonary disease: a comparison of the Charlson and Elixhauser comorbidity indices.

Publications

Comorbidity and thirty-day hospital readmission odds in chronic obstructive pulmonary disease: a comparison of the Charlson and Elixhauser comorbidity indices.

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