Title

The central role of comorbidity in predicting ambulatory care sensitive hospitalizations

Authors

Barry G. Saver, University of Massachusetts Medical School
Ching-Yun Wang, Fred Hutchinson Cancer Research Center
Sharon A. Dobie, University of Washington School of Medicine
Pamela K. Green, University of Washington School of Medicine
Laura-Mae Baldwin, University of Washington School of Medicine

UMMS Affiliation

Meyers Primary Care Institute; Department of Family Medicine and Community Health

Publication Date

2013-03-28

Document Type

Article

Subjects

Ambulatory Care; Hospitalization; Comorbidity

Disciplines

Epidemiology | Health Services Research | Primary Care | Public Health

Abstract

BACKGROUND: Ambulatory care sensitive hospitalizations (ACSHs) are commonly used as measures of access to and quality of care. They are defined as hospitalizations for certain acute and chronic conditions; yet, they are most commonly used in analyses comparing different groups without adjustment for individual-level comorbidity. We present an exploration of their roles in predicting ACSHs for acute and chronic conditions.

METHODS: Using 1998-99 US Medicare claims for 1 06 930 SEER-Medicare control subjects and 1999 Area Resource File data, we modelled occurrence of acute and chronic ACSHs with logistic regression, examining effects of different predictors on model discriminatory power.

RESULTS: Flags for the presence of a few comorbid conditions-congestive heart failure, chronic obstructive pulmonary disease, diabetes, hypertension and, for acute ACSHs, dementia-contributed virtually all of the discriminative ability for predicting ACSHs. C-statistics were up to 0.96 for models predicting chronic ACSHs and up to 0.87 for predicting acute ACSHs. C-statistics for models lacking comorbidity flags were lower, at best 0.73, for both acute and chronic ACSHs.

CONCLUSION: Comorbidity is far more important in predicting ACSH risk than any other factor, both for acute and chronic ACSHs. Imputations about quality and access should not be made from analyses that do not control for presence of important comorbid conditions. Acute and chronic ACSHs differ enough that they should be modelled separately. Unaggregated models restricted to persons with the relevant diagnoses are most appropriate for chronic ACSHs.

DOI of Published Version

10.1093/eurpub/ckt019

Source

Eur J Public Health. 2013 Mar 28. Link to article on publisher's site

Journal/Book/Conference Title

European journal of public health

Related Resources

Link to Article in PubMed

PubMed ID

23543676

Repository Citation

Saver BG, Wang C, Dobie SA, Green PK, Baldwin L. (2013). The central role of comorbidity in predicting ambulatory care sensitive hospitalizations. Meyers Health Care Institute Publications. https://doi.org/10.1093/eurpub/ckt019. Retrieved from https://escholarship.umassmed.edu/meyers_pp/656