TY - JOUR
T1 - A multipurpose comorbidity scoring system performed better than the Charlson index
AU - Holman, C. D.Arcy J.
AU - Preen, David B.
AU - Baynham, Natalya J.
AU - Finn, Judith C.
AU - Semmens, James B.
PY - 2005/10/1
Y1 - 2005/10/1
N2 - Background and Objectives: To develop a comorbidity scoring system that out-performs the Charlson index. Methods: Population-based cohorts of medical (n = 326,456), procedural (n = 349,686), and psychiatric (n = 16,895) inpatients in Western Australia were followed for 1-year mortality, 30-day readmissions, and length of stay (LOS) using data linkage. Conditions were identified at index admission and over the preceding 12 months. A Multipurpose Australian Comorbidity Scoring System (MACSS) was developed, based on the most frequent 102 comorbid conditions associated with a rate ratio (RR) ≥ 1.1 of death or readmission or a LOS difference ≥0.5 days. The performance of MACSS and the Charlson index in predicting mortality, readmission, and LOS, and in controlling confounding by comorbidity, was compared in five test scenarios involving asthma, myocardial infarction, mastectomy, transurethral prostatectomy, and major depressive illness. Results: MACSS performed better than the Charlson index on all three outcomes in all five clinical groups. It reduced the failure of the Charlson index to discriminate on mortality and readmission outcomes by 5-40%, improved R2 in LOS models by up to fourfold and often doubled the correction of originally confounded effect measures. Conclusion: The use of the MACSS and similar alternatives to the Charlson index are a new methodologic standard for adjustment of comorbidity risk.
AB - Background and Objectives: To develop a comorbidity scoring system that out-performs the Charlson index. Methods: Population-based cohorts of medical (n = 326,456), procedural (n = 349,686), and psychiatric (n = 16,895) inpatients in Western Australia were followed for 1-year mortality, 30-day readmissions, and length of stay (LOS) using data linkage. Conditions were identified at index admission and over the preceding 12 months. A Multipurpose Australian Comorbidity Scoring System (MACSS) was developed, based on the most frequent 102 comorbid conditions associated with a rate ratio (RR) ≥ 1.1 of death or readmission or a LOS difference ≥0.5 days. The performance of MACSS and the Charlson index in predicting mortality, readmission, and LOS, and in controlling confounding by comorbidity, was compared in five test scenarios involving asthma, myocardial infarction, mastectomy, transurethral prostatectomy, and major depressive illness. Results: MACSS performed better than the Charlson index on all three outcomes in all five clinical groups. It reduced the failure of the Charlson index to discriminate on mortality and readmission outcomes by 5-40%, improved R2 in LOS models by up to fourfold and often doubled the correction of originally confounded effect measures. Conclusion: The use of the MACSS and similar alternatives to the Charlson index are a new methodologic standard for adjustment of comorbidity risk.
KW - Administrative data
KW - Comorbidity
KW - Data linkage
KW - Hospital morbidity
KW - Methods
KW - Risk adjustment
UR - http://www.scopus.com/inward/record.url?scp=24944580881&partnerID=8YFLogxK
U2 - 10.1016/j.jclinepi.2005.01.020
DO - 10.1016/j.jclinepi.2005.01.020
M3 - Article
C2 - 16168346
AN - SCOPUS:24944580881
SN - 0895-4356
VL - 58
SP - 1006
EP - 1014
JO - Journal of Clinical Epidemiology
JF - Journal of Clinical Epidemiology
IS - 10
ER -