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Apples and Oranges: Four Definitions of Multiple Chronic Conditions and their Relationship to 30‐Day Hospital Readmission
Author(s) -
Dattalo Melissa,
DuGoff Eva,
Ronk Katie,
Kennelty Korey,
GilmoreBykovskyi Andrea,
Kind Amy J.
Publication year - 2017
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.14539
Subject(s) - medicine , confidence interval , odds ratio , comorbidity , logistic regression , retrospective cohort study , cohort , emergency medicine
Objectives To determine the extent of agreement between four commonly used definitions of multiple chronic conditions ( MCC s) and compare each definition's ability to predict 30‐day hospital readmissions. Design Retrospective cohort study. Setting National Medicare claims data. Participants Random sample of Medicare beneficiaries discharged from the hospital from 2005 to 2009 (n = 710,609). Measurements Baseline chronic conditions were determined for each participant using four definitions of MCC . The primary outcome was all‐cause 30‐day hospital readmission. Agreement between MCC definitions was measured, and sensitivities and specificities for each definition's ability to identify patients experiencing a future readmission were calculated. Logistic regression was used to assess the ability of each MCC definition to predict 30‐day hospital readmission. Results The sample prevalence of hospitalized Medicare beneficiaries with two or more chronic conditions ranged from 18.6% (Johns Hopkins Adjusted Clinical Groups ( ACG ) Case‐Mix System software) to 92.9% (Medicare Chronic Condition Warehouse ( CCW )). There was slight to moderate agreement (kappa = 0.03–0.44) between pair‐wise combinations of MCC definitions. CCW ‐defined MCC was the most sensitive (sensitivity 95.4%, specificity 7.4%), and ACG ‐defined MCC was the most specific (sensitivity 32.7%, specificity 83.2%) predictor of being readmitted. In the fully adjusted model, the risk of readmission was higher for those with chronic condition Special Needs Plan (c‐ SNP )‐defined MCC s (odds ratio ( OR ) = 1.50, 95% confidence interval ( CI ) = 1.47–1.52), Charlson Comorbidity Index–defined MCC s ( OR = 1.45, 95% CI = 1.42–1.47), ACG ‐defined MCC s ( OR = 1.22, 95% CI = 1.19–1.25), and CCW ‐defined MCC s ( OR = 1.15, 95% CI = 1.11–1.19) than for those without MCC s. Conclusion MCC definitions demonstrate poor agreement and should not be used interchangeably. The two definitions with the greatest agreement ( CCI , c‐ SNP ) were also the best predictors of 30‐day hospital readmissions.