External validation and comparison of two variants of the Elixhauser comorbidity measures for all-cause mortality

被引：20

作者：

Fortin, Yannick ^{[1
,2
]}

Crispo, James A. G. ^{[1
,2
,3
]}

Cohen, Deborah ^{[2
,4
,5
]}

McNair, Douglas S. ^{[6
]}

Mattison, Donald R. ^{[1
,7
]}

Krewski, Daniel ^{[1
,2
,7
]}

机构：

[1] Univ Ottawa, McLaughlin Ctr Populat Hlth Risk Assessment, Ottawa, ON, Canada

[2] Univ Ottawa, Sch Epidemiol Publ Hlth & Prevent Med, Ottawa, ON, Canada

[3] Univ Penn, Philadelphia, PA 19104 USA

[4] CIHI, CPHI, Ottawa, ON, Canada

[5] Univ Toronto, Inst Hlth Policy Management & Evaluat, Toronto, ON, Canada

[6] Cerner Corp, Kansas City, MO USA

[7] Risk Sci Int, Ottawa, ON, Canada

来源：

PLOS ONE | 2017年 / 12卷 / 03期

关键词：

ADMINISTRATIVE DATA; PERFORMANCE; SCORES; INFORMATION; ADJUSTMENT; CHARLSON; INDEXES; MODEL;

D O I：

10.1371/journal.pone.0174379

中图分类号：

O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];

学科分类号：

07 ; 0710 ; 09 ;

摘要：

Assessing prevalent comorbidities is a common approach in health research for identifying clinical differences between individuals. The objective of this study was to validate and compare the predictive performance of two variants of the Elixhauser comorbidity measures (ECM) for inhospital mortality at index and at 1-year in the Cerner Health Facts (R) (HF) U.S. database. We estimated the prevalence of select comorbidities for individuals 18 to 89 years of age who received care at Cerner contributing health facilities between 2002 and 2011 using the AHRQ (version 3.7) and the Quan Enhanced ICD-9-CM ECMs. External validation of the ECMs was assessed with measures of discrimination [c-statistics], calibration [Hosmer Lemeshow goodness-of-fit test, Brier Score, calibration curves], added predictive ability [Net Reclassification Improvement], and overall model performance [R-2]. Of 3,273,298 patients with a mean age of 43.9 years and a female composition of 53.8%, 1.0% died during their index encounter and 1.5% were deceased at 1-year. Calibration measures were equivalent between the two ECMs. Calibration performance was acceptable when predicting inhospital mortality at index, although recalibration is recommended for predicting inhospital mortality at 1 year. Discrimination was marginally better with the Quan ECM compared the AHRQ ECM when predicting inhospital mortality at index (C-Quan =0.887, 95% CI: 0.885-0.889 vs. cAHRQ = 0.880, 95% CI: 0.878-0.882; p <.0001) and at 1-year (c(Quan) 0.884, 95% CI: 0.883-0.886 vs. c(AHRQ) = 0.880, 95% CI: 0.878-0.881, p < .0001). Both the Quan and the AHRQ ECMs demonstrated excellent discrimination for inhospital mortality of all-causes in Cerner Health Facts (R), a HIPAA compliant observational research and privacy protected data warehouse. While differences in discrimination performance between the ECMs were statistically significant, they are not likely clinically meaningful.

引用

页数：16

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