Journal article
Apples and Oranges: Four Definitions of Multiple Chronic Conditions and their Relationship to 30-Day Hospital Readmission
Journal of the American Geriatrics Society (JAGS), Vol.65(4), pp.712-720
04/2017
DOI: 10.1111/jgs.14539
PMCID: PMC5397355
PMID: 28205206
Abstract
To determine the extent of agreement between four commonly used definitions of multiple chronic conditions (MCCs) and compare each definition's ability to predict 30-day hospital readmissions.
Retrospective cohort study.
National Medicare claims data.
Random sample of Medicare beneficiaries discharged from the hospital from 2005 to 2009 (n = 710,609).
Baseline chronic conditions were determined for each participant using four definitions of MCC. The primary outcome was all-cause 30-day hospital readmission. Agreement between MCC definitions was measured, and sensitivities and specificities for each definition's ability to identify patients experiencing a future readmission were calculated. Logistic regression was used to assess the ability of each MCC definition to predict 30-day hospital readmission.
The sample prevalence of hospitalized Medicare beneficiaries with two or more chronic conditions ranged from 18.6% (Johns Hopkins Adjusted Clinical Groups (ACG) Case-Mix System software) to 92.9% (Medicare Chronic Condition Warehouse (CCW)). There was slight to moderate agreement (kappa = 0.03-0.44) between pair-wise combinations of MCC definitions. CCW-defined MCC was the most sensitive (sensitivity 95.4%, specificity 7.4%), and ACG-defined MCC was the most specific (sensitivity 32.7%, specificity 83.2%) predictor of being readmitted. In the fully adjusted model, the risk of readmission was higher for those with chronic condition Special Needs Plan (c-SNP)-defined MCCs (odds ratio (OR) = 1.50, 95% confidence interval (CI) = 1.47-1.52), Charlson Comorbidity Index-defined MCCs (OR = 1.45, 95% CI = 1.42-1.47), ACG-defined MCCs (OR = 1.22, 95% CI = 1.19-1.25), and CCW-defined MCCs (OR = 1.15, 95% CI = 1.11-1.19) than for those without MCCs.
MCC definitions demonstrate poor agreement and should not be used interchangeably. The two definitions with the greatest agreement (CCI, c-SNP) were also the best predictors of 30-day hospital readmissions.
Details
- Title: Subtitle
- Apples and Oranges: Four Definitions of Multiple Chronic Conditions and their Relationship to 30-Day Hospital Readmission
- Creators
- Melissa Dattalo - Division of Geriatrics, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WisconsinEva DuGoff - Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, WisconsinKatie Ronk - Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, WisconsinKorey Kennelty - School of Pharmacy, University of Wisconsin, Madison, WisconsinAndrea Gilmore-Bykovskyi - School of Nursing, University of Wisconsin, Madison, WisconsinAmy J Kind - School of Nursing, University of Wisconsin, Madison, Wisconsin
- Resource Type
- Journal article
- Publication Details
- Journal of the American Geriatrics Society (JAGS), Vol.65(4), pp.712-720
- DOI
- 10.1111/jgs.14539
- PMID
- 28205206
- PMCID
- PMC5397355
- NLM abbreviation
- J Am Geriatr Soc
- ISSN
- 0002-8614
- eISSN
- 1532-5415
- Publisher
- Wiley; United States
- Grant note
- UL1 TR000427 / NCATS NIH HHS R01 MD010243 / NIMHD NIH HHS P50 AG033514 / NIA NIH HHS R01 AG050504 / NIA NIH HHS K23 AG034551 / NIA NIH HHS
- Language
- English
- Date published
- 04/2017
- Academic Unit
- Family and Community Medicine; Pharmacy Practice and Science; Injury Prevention Research Center
- Record Identifier
- 9984065691502771
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