TY - JOUR
T1 - Best Definitions of Multimorbidity to Identify Patients With High Health Care Resource Utilization
AU - Aubert, Carole E.
AU - Schnipper, Jeffrey L.
AU - Roumet, Marie
AU - Marques-Vidal, Pedro
AU - Stirnemann, Jérôme
AU - Auerbach, Andrew D.
AU - Zimlichman, Eyal
AU - Kripalani, Sunil
AU - Vasilevskis, Eduard E.
AU - Robinson, Edmondo
AU - Fletcher, Grant S.
AU - Aujesky, Drahomir
AU - Limacher, Andreas
AU - Donzé, Jacques
N1 - Publisher Copyright:
© 2019 Mayo Foundation for Medical Education and Research
PY - 2020/2
Y1 - 2020/2
N2 - Objective: To compare different definitions of multimorbidity to identify patients with higher health care resource utilization. Patients and Methods: We used a multinational retrospective cohort including 147,806 medical inpatients discharged from 11 hospitals in 3 countries (United States, Switzerland, and Israel) between January 1, 2010, and December 31, 2011. We compared the area under the receiver operating characteristic curve (AUC) of 8 definitions of multimorbidity, based on International Classification of Diseases codes defining health conditions, the Deyo-Charlson Comorbidity Index, the Elixhauser-van Walraven Comorbidity Index, body systems, or Clinical Classification Software categories to predict 30-day hospital readmission and/or prolonged length of stay (longer than or equal to the country-specific upper quartile). We used a lower (yielding sensitivity ≥90%) and an upper (yielding specificity ≥60%) cutoff to create risk categories. Results: Definitions had poor to fair discriminatory power in the derivation (AUC, 0.61-0.65) and validation cohorts (AUC, 0.64-0.71). The definitions with the highest AUC were number of (1) health conditions with involvement of 2 or more body systems, (2) body systems, (3) Clinical Classification Software categories, and (4) health conditions. At the upper cutoff, sensitivity and specificity were 65% to 79% and 50% to 53%, respectively, in the validation cohort; of the 147,806 patients, 5% to 12% (7474 to 18,008) were classified at low risk, 38% to 55% (54,484 to 81,540) at intermediate risk, and 32% to 50% (47,331 to 72,435) at high risk. Conclusion: Of the 8 definitions of multimorbidity, 4 had comparable discriminatory power to identify patients with higher health care resource utilization. Of these 4, the number of health conditions may represent the easiest definition to apply in clinical routine. The cutoff chosen, favoring sensitivity or specificity, should be determined depending on the aim of the definition.
AB - Objective: To compare different definitions of multimorbidity to identify patients with higher health care resource utilization. Patients and Methods: We used a multinational retrospective cohort including 147,806 medical inpatients discharged from 11 hospitals in 3 countries (United States, Switzerland, and Israel) between January 1, 2010, and December 31, 2011. We compared the area under the receiver operating characteristic curve (AUC) of 8 definitions of multimorbidity, based on International Classification of Diseases codes defining health conditions, the Deyo-Charlson Comorbidity Index, the Elixhauser-van Walraven Comorbidity Index, body systems, or Clinical Classification Software categories to predict 30-day hospital readmission and/or prolonged length of stay (longer than or equal to the country-specific upper quartile). We used a lower (yielding sensitivity ≥90%) and an upper (yielding specificity ≥60%) cutoff to create risk categories. Results: Definitions had poor to fair discriminatory power in the derivation (AUC, 0.61-0.65) and validation cohorts (AUC, 0.64-0.71). The definitions with the highest AUC were number of (1) health conditions with involvement of 2 or more body systems, (2) body systems, (3) Clinical Classification Software categories, and (4) health conditions. At the upper cutoff, sensitivity and specificity were 65% to 79% and 50% to 53%, respectively, in the validation cohort; of the 147,806 patients, 5% to 12% (7474 to 18,008) were classified at low risk, 38% to 55% (54,484 to 81,540) at intermediate risk, and 32% to 50% (47,331 to 72,435) at high risk. Conclusion: Of the 8 definitions of multimorbidity, 4 had comparable discriminatory power to identify patients with higher health care resource utilization. Of these 4, the number of health conditions may represent the easiest definition to apply in clinical routine. The cutoff chosen, favoring sensitivity or specificity, should be determined depending on the aim of the definition.
UR - http://www.scopus.com/inward/record.url?scp=85107433915&partnerID=8YFLogxK
U2 - 10.1016/j.mayocpiqo.2019.09.002
DO - 10.1016/j.mayocpiqo.2019.09.002
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AN - SCOPUS:85107433915
SN - 2542-4548
VL - 4
SP - 40
EP - 49
JO - Mayo Clinic Proceedings: Innovations, Quality and Outcomes
JF - Mayo Clinic Proceedings: Innovations, Quality and Outcomes
IS - 1
ER -