Common comorbidity scales were similar in their ability to predict health care costs and mortality

Anthony J. Perkins, Kurt Kroenke, Jürgen Unützer, Wayne Katon, John W. Williams, Carol Hope, Christopher M. Callahan

Research output: Contribution to journalArticle

262 Citations (Scopus)

Abstract

Objective To compare the ability of commonly used measures of medical comorbidity (ambulatory care groups [ACGs], Charlson comorbidity index, chronic disease score, number of prescribed medications, and number of chronic diseases) to predict mortality and health care costs over 1 year. Study Design and Setting A prospective cohort study of community-dwelling older adults (n=3,496) attending a large primary care practice. Results For predicting health care charges, the number of medications had the highest predictive validity (R 2 = 13.6%) after adjusting for demographics. ACGs (R 2=16.4%) and the number of medications (15.0%) had the highest predictive validity for predicting ambulatory visits. ACGs and the Charlson comorbidity index (area under the receiver operator characteristic [ROC] curve=0.695-0.767) performed better than medication-based measures (area under the ROC curve=0.662-0.679) for predicting mortality. There is relatively little difference, however, in the predictive validity across these scales. Conclusion In an outpatient setting, a simple count of medications may be the most efficient comorbidity measure for predicting utilization and health-care charges over the ensuing year. In contrast, diagnosis-based measures have greater predictive validity for 1-year mortality. Current comorbidity measures, however, have only poor to moderate predictive validity for costs or mortality over 1 year.

Original languageEnglish (US)
Pages (from-to)1040-1048
Number of pages9
JournalJournal of Clinical Epidemiology
Volume57
Issue number10
DOIs
StatePublished - Oct 1 2004

Fingerprint

Health Care Costs
Comorbidity
Ambulatory Care
Mortality
Chronic Disease
Patient Acceptance of Health Care
Independent Living
Primary Health Care
Cohort Studies
Outpatients
Demography
Prospective Studies
Delivery of Health Care
Costs and Cost Analysis

Keywords

  • Chronic disease
  • Comorbidity
  • Mortality
  • Utilization

ASJC Scopus subject areas

  • Medicine(all)
  • Public Health, Environmental and Occupational Health
  • Epidemiology

Cite this

Common comorbidity scales were similar in their ability to predict health care costs and mortality. / Perkins, Anthony J.; Kroenke, Kurt; Unützer, Jürgen; Katon, Wayne; Williams, John W.; Hope, Carol; Callahan, Christopher M.

In: Journal of Clinical Epidemiology, Vol. 57, No. 10, 01.10.2004, p. 1040-1048.

Research output: Contribution to journalArticle

Perkins, Anthony J. ; Kroenke, Kurt ; Unützer, Jürgen ; Katon, Wayne ; Williams, John W. ; Hope, Carol ; Callahan, Christopher M. / Common comorbidity scales were similar in their ability to predict health care costs and mortality. In: Journal of Clinical Epidemiology. 2004 ; Vol. 57, No. 10. pp. 1040-1048.
@article{bf0be29bc6734f6793ddd1e813c85f09,
title = "Common comorbidity scales were similar in their ability to predict health care costs and mortality",
abstract = "Objective To compare the ability of commonly used measures of medical comorbidity (ambulatory care groups [ACGs], Charlson comorbidity index, chronic disease score, number of prescribed medications, and number of chronic diseases) to predict mortality and health care costs over 1 year. Study Design and Setting A prospective cohort study of community-dwelling older adults (n=3,496) attending a large primary care practice. Results For predicting health care charges, the number of medications had the highest predictive validity (R 2 = 13.6{\%}) after adjusting for demographics. ACGs (R 2=16.4{\%}) and the number of medications (15.0{\%}) had the highest predictive validity for predicting ambulatory visits. ACGs and the Charlson comorbidity index (area under the receiver operator characteristic [ROC] curve=0.695-0.767) performed better than medication-based measures (area under the ROC curve=0.662-0.679) for predicting mortality. There is relatively little difference, however, in the predictive validity across these scales. Conclusion In an outpatient setting, a simple count of medications may be the most efficient comorbidity measure for predicting utilization and health-care charges over the ensuing year. In contrast, diagnosis-based measures have greater predictive validity for 1-year mortality. Current comorbidity measures, however, have only poor to moderate predictive validity for costs or mortality over 1 year.",
keywords = "Chronic disease, Comorbidity, Mortality, Utilization",
author = "Perkins, {Anthony J.} and Kurt Kroenke and J{\"u}rgen Un{\"u}tzer and Wayne Katon and Williams, {John W.} and Carol Hope and Callahan, {Christopher M.}",
year = "2004",
month = "10",
day = "1",
doi = "10.1016/j.jclinepi.2004.03.002",
language = "English (US)",
volume = "57",
pages = "1040--1048",
journal = "Journal of Clinical Epidemiology",
issn = "0895-4356",
publisher = "Elsevier USA",
number = "10",

}

TY - JOUR

T1 - Common comorbidity scales were similar in their ability to predict health care costs and mortality

AU - Perkins, Anthony J.

AU - Kroenke, Kurt

AU - Unützer, Jürgen

AU - Katon, Wayne

AU - Williams, John W.

AU - Hope, Carol

AU - Callahan, Christopher M.

PY - 2004/10/1

Y1 - 2004/10/1

N2 - Objective To compare the ability of commonly used measures of medical comorbidity (ambulatory care groups [ACGs], Charlson comorbidity index, chronic disease score, number of prescribed medications, and number of chronic diseases) to predict mortality and health care costs over 1 year. Study Design and Setting A prospective cohort study of community-dwelling older adults (n=3,496) attending a large primary care practice. Results For predicting health care charges, the number of medications had the highest predictive validity (R 2 = 13.6%) after adjusting for demographics. ACGs (R 2=16.4%) and the number of medications (15.0%) had the highest predictive validity for predicting ambulatory visits. ACGs and the Charlson comorbidity index (area under the receiver operator characteristic [ROC] curve=0.695-0.767) performed better than medication-based measures (area under the ROC curve=0.662-0.679) for predicting mortality. There is relatively little difference, however, in the predictive validity across these scales. Conclusion In an outpatient setting, a simple count of medications may be the most efficient comorbidity measure for predicting utilization and health-care charges over the ensuing year. In contrast, diagnosis-based measures have greater predictive validity for 1-year mortality. Current comorbidity measures, however, have only poor to moderate predictive validity for costs or mortality over 1 year.

AB - Objective To compare the ability of commonly used measures of medical comorbidity (ambulatory care groups [ACGs], Charlson comorbidity index, chronic disease score, number of prescribed medications, and number of chronic diseases) to predict mortality and health care costs over 1 year. Study Design and Setting A prospective cohort study of community-dwelling older adults (n=3,496) attending a large primary care practice. Results For predicting health care charges, the number of medications had the highest predictive validity (R 2 = 13.6%) after adjusting for demographics. ACGs (R 2=16.4%) and the number of medications (15.0%) had the highest predictive validity for predicting ambulatory visits. ACGs and the Charlson comorbidity index (area under the receiver operator characteristic [ROC] curve=0.695-0.767) performed better than medication-based measures (area under the ROC curve=0.662-0.679) for predicting mortality. There is relatively little difference, however, in the predictive validity across these scales. Conclusion In an outpatient setting, a simple count of medications may be the most efficient comorbidity measure for predicting utilization and health-care charges over the ensuing year. In contrast, diagnosis-based measures have greater predictive validity for 1-year mortality. Current comorbidity measures, however, have only poor to moderate predictive validity for costs or mortality over 1 year.

KW - Chronic disease

KW - Comorbidity

KW - Mortality

KW - Utilization

UR - http://www.scopus.com/inward/record.url?scp=7444225769&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=7444225769&partnerID=8YFLogxK

U2 - 10.1016/j.jclinepi.2004.03.002

DO - 10.1016/j.jclinepi.2004.03.002

M3 - Article

C2 - 15528055

AN - SCOPUS:7444225769

VL - 57

SP - 1040

EP - 1048

JO - Journal of Clinical Epidemiology

JF - Journal of Clinical Epidemiology

SN - 0895-4356

IS - 10

ER -