Title
The central role of comorbidity in predicting ambulatory care sensitive hospitalizations
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
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 Primary Care Institute Publications. https://doi.org/10.1093/eurpub/ckt019. Retrieved from https://escholarship.umassmed.edu/meyers_pp/656