Selecting a patient characteristics index for the prediction of medical outcomes using administrative claims data

C. Melfi, E. Holleman, D. Arthur, Barry Katz

Research output: Contribution to journalArticle

108 Citations (Scopus)

Abstract

Recently, there has been a great deal of discussion regarding the use of administrative databases to study outcomes of medical care. A major issue in this discussion is how to classify patients in terms of characteristics such as disease-severity, comorbidities, resource needs, stability, etc. Different indices have been developed in an attempt to provide a common classification scheme in terms of these characteristics. In this paper, we examine the utility of four indices in the prediction of length of stay and 30-day mortality for patients undergoing total knee replacement surgery between 1985 and 1989. The indices that we compare are the Deyo-adapted Charlson Index, the Relative Intensity Score derived from Patient Management Categories (PMCs), the Patient Severity Level derived from PMCs, and the number of diagnoses (up to five) listed in the Medicare claims data. The first three of these indices represent measures of comorbidity, resource use, and severity of illness, respectively. The number of diagnoses is likely to capture aspects of each of these characteristics. We find that all of the indices improve (in terms of model fit) over the baseline (no index) models of length of stay and mortality, and the Relative Intensity Score and Patient Severity Level result in the greatest improvement in measures of model fit. We found, however, that these two indices have a non-monotonic relationship with length of stay and mortality. The Deyo-adapted Charlson Index performed least well of the four indices in terms of explanatory ability. The number of diagnoses performed well, and does not suffer from problems associated with miscoding on claims data.

Original languageEnglish
Pages (from-to)917-926
Number of pages10
JournalJournal of Clinical Epidemiology
Volume48
Issue number7
DOIs
StatePublished - 1995

Fingerprint

Length of Stay
Mortality
Comorbidity
Knee Replacement Arthroplasties
Medicare
Outcome Assessment (Health Care)
Databases

Keywords

  • Administrative data
  • Comorbidity
  • Health status
  • Illness severity
  • Knee replacement
  • Outcomes

ASJC Scopus subject areas

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

Cite this

Selecting a patient characteristics index for the prediction of medical outcomes using administrative claims data. / Melfi, C.; Holleman, E.; Arthur, D.; Katz, Barry.

In: Journal of Clinical Epidemiology, Vol. 48, No. 7, 1995, p. 917-926.

Research output: Contribution to journalArticle

@article{7b5108b10d0f4f5085f61f71c3e6650b,
title = "Selecting a patient characteristics index for the prediction of medical outcomes using administrative claims data",
abstract = "Recently, there has been a great deal of discussion regarding the use of administrative databases to study outcomes of medical care. A major issue in this discussion is how to classify patients in terms of characteristics such as disease-severity, comorbidities, resource needs, stability, etc. Different indices have been developed in an attempt to provide a common classification scheme in terms of these characteristics. In this paper, we examine the utility of four indices in the prediction of length of stay and 30-day mortality for patients undergoing total knee replacement surgery between 1985 and 1989. The indices that we compare are the Deyo-adapted Charlson Index, the Relative Intensity Score derived from Patient Management Categories (PMCs), the Patient Severity Level derived from PMCs, and the number of diagnoses (up to five) listed in the Medicare claims data. The first three of these indices represent measures of comorbidity, resource use, and severity of illness, respectively. The number of diagnoses is likely to capture aspects of each of these characteristics. We find that all of the indices improve (in terms of model fit) over the baseline (no index) models of length of stay and mortality, and the Relative Intensity Score and Patient Severity Level result in the greatest improvement in measures of model fit. We found, however, that these two indices have a non-monotonic relationship with length of stay and mortality. The Deyo-adapted Charlson Index performed least well of the four indices in terms of explanatory ability. The number of diagnoses performed well, and does not suffer from problems associated with miscoding on claims data.",
keywords = "Administrative data, Comorbidity, Health status, Illness severity, Knee replacement, Outcomes",
author = "C. Melfi and E. Holleman and D. Arthur and Barry Katz",
year = "1995",
doi = "10.1016/0895-4356(94)00202-2",
language = "English",
volume = "48",
pages = "917--926",
journal = "Journal of Clinical Epidemiology",
issn = "0895-4356",
publisher = "Elsevier USA",
number = "7",

}

TY - JOUR

T1 - Selecting a patient characteristics index for the prediction of medical outcomes using administrative claims data

AU - Melfi, C.

AU - Holleman, E.

AU - Arthur, D.

AU - Katz, Barry

PY - 1995

Y1 - 1995

N2 - Recently, there has been a great deal of discussion regarding the use of administrative databases to study outcomes of medical care. A major issue in this discussion is how to classify patients in terms of characteristics such as disease-severity, comorbidities, resource needs, stability, etc. Different indices have been developed in an attempt to provide a common classification scheme in terms of these characteristics. In this paper, we examine the utility of four indices in the prediction of length of stay and 30-day mortality for patients undergoing total knee replacement surgery between 1985 and 1989. The indices that we compare are the Deyo-adapted Charlson Index, the Relative Intensity Score derived from Patient Management Categories (PMCs), the Patient Severity Level derived from PMCs, and the number of diagnoses (up to five) listed in the Medicare claims data. The first three of these indices represent measures of comorbidity, resource use, and severity of illness, respectively. The number of diagnoses is likely to capture aspects of each of these characteristics. We find that all of the indices improve (in terms of model fit) over the baseline (no index) models of length of stay and mortality, and the Relative Intensity Score and Patient Severity Level result in the greatest improvement in measures of model fit. We found, however, that these two indices have a non-monotonic relationship with length of stay and mortality. The Deyo-adapted Charlson Index performed least well of the four indices in terms of explanatory ability. The number of diagnoses performed well, and does not suffer from problems associated with miscoding on claims data.

AB - Recently, there has been a great deal of discussion regarding the use of administrative databases to study outcomes of medical care. A major issue in this discussion is how to classify patients in terms of characteristics such as disease-severity, comorbidities, resource needs, stability, etc. Different indices have been developed in an attempt to provide a common classification scheme in terms of these characteristics. In this paper, we examine the utility of four indices in the prediction of length of stay and 30-day mortality for patients undergoing total knee replacement surgery between 1985 and 1989. The indices that we compare are the Deyo-adapted Charlson Index, the Relative Intensity Score derived from Patient Management Categories (PMCs), the Patient Severity Level derived from PMCs, and the number of diagnoses (up to five) listed in the Medicare claims data. The first three of these indices represent measures of comorbidity, resource use, and severity of illness, respectively. The number of diagnoses is likely to capture aspects of each of these characteristics. We find that all of the indices improve (in terms of model fit) over the baseline (no index) models of length of stay and mortality, and the Relative Intensity Score and Patient Severity Level result in the greatest improvement in measures of model fit. We found, however, that these two indices have a non-monotonic relationship with length of stay and mortality. The Deyo-adapted Charlson Index performed least well of the four indices in terms of explanatory ability. The number of diagnoses performed well, and does not suffer from problems associated with miscoding on claims data.

KW - Administrative data

KW - Comorbidity

KW - Health status

KW - Illness severity

KW - Knee replacement

KW - Outcomes

UR - http://www.scopus.com/inward/record.url?scp=0029044623&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0029044623&partnerID=8YFLogxK

U2 - 10.1016/0895-4356(94)00202-2

DO - 10.1016/0895-4356(94)00202-2

M3 - Article

VL - 48

SP - 917

EP - 926

JO - Journal of Clinical Epidemiology

JF - Journal of Clinical Epidemiology

SN - 0895-4356

IS - 7

ER -