A new comorbidity index: the health-related quality of life comorbidity index
ABSTRACT To derive and validate the health-related quality of life comorbidity index (HRQL-CI).
Of 261 clinical classification codes (CCCs) in the 2003 Medical Expenditure Panel Survey (MEPS), 44 were identified as adult, gender-neutral, chronic conditions. The least absolute shrinkage and selection operator (LASSO) procedure identified CCCs significantly associated with the Short Form-12 physical component summary (PCS) and mental component summary (MCS) scores. Regression models were fitted with the selected CCCs, resulting in two subsets corresponding to PCS and MCS, collectively called the HRQL-CI. Internal validation was assessed using 10-fold cross-validation, whereas external validation in terms of prediction accuracy was assessed in the 2005 MEPS database. Prediction errors and model R² were compared between HRQL-CI models and models using the Charlson-CI.
LASSO identified 20 CCCs significantly associated with PCS and 15 with MCS. The R² for the models, including the HRQL-CI (0.28 for PCS and 0.16 for MCS) were greater than those using the Charlson-CI (0.13 for PCS and 0.01 for MCS). The same pattern of higher R² for models using the HRQL-CI was observed in the validation tests.
The HRQL-CI is a valid risk adjustment index, outperforming the Charlson-CI. Further work is needed to test its performance in other patient populations and measures of HRQL.
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ABSTRACT: Background Since approximately two in three older adults (65+) report having two or more chronic diseases, causes and consequences of multimorbidity among older persons has important personal and societal issues. Indeed, having more than one chronic condition might involve synergetic effects, which can increase impact on disabilities and quality of life of older adults. Moreover, persons with multimorbidity require more health care treatments, implying burden for the person, her/his family and the health care system. Methods Using the 2008/09 Canadian Community Health Survey (CCHS), this paper assesses the convergent construct validity of six measures of multimorbidity for persons aged 65 and over. These measures include: 1) Multimorbidity Dichotomized (0, 1+ conditions); 2) Multimorbidity Dichotomized (0/1, 2+); 3) Multimorbidity Additive Scale; 4) Multimorbidity Weighted by the Health Utility (HUI3) Scale; 5) Multimorbidity Weighted by the OARS Activity of Daily Living (ADL) Scale; and 6) Multimorbidity Weighted by HUI3 (using beta coefficients). Convergent construct validity was assessed using correlations and OLS regression coefficients for each of the multimorbidity measures with the following social-psychological and health outcome variables: life satisfaction, perceived health, number of health professional visits, and medication use. Results Overall, the two dichotomies (scales #1 & #2) showed the weakest construct validity with the health outcome variables. The additive chronic illness scale (#3) and the multimorbidity weighted by ADLs (#5), performed better than the other two weighted scales using (HUI #4 & #6). Measurement errors apparent in the dichotomous multimorbidity measures were amplified for older women, especially for life satisfaction and perceived health, but decreased when using the scales, suggesting stronger validity of scales #3 through #6. Conclusions To properly represent multimorbidity, using dichotomous measures should be used with caution. When only prevalence data are available for chronic conditions, such as in the CCHSs or CLSA, an additive multimorbidity scale can better measure total illness burden than simple dichotomous or other discrete measures.BMC Geriatrics 12/2015; 15(1). DOI:10.1186/s12877-015-0001-8 · 2.00 Impact Factor
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ABSTRACT: Health-related quality of life (HRQoL) in patients treated in intensive care has been reported to be lower compared with age and sex-adjusted control groups. Our aim was to test whether stratifying for coexisting conditions would reduce observed differences in HRQoL between patients treated in the ICU and a control group from the normal population. We also wanted to characterise the ICU patients with the lowest HRQoL within these strata. We did a cross-sectional comparison of scores of the short form health survey (SF-36) questionnaire in a multicenter study of patients treated in the ICU (n = 780) and those from a local public health survey (n = 6093). Analyses were in both groups adjusted for age and sex, and data stratified for coexisting conditions. Within each strata patients with low scores (below - 2 SD of the control group) were identified and characterised. After adjustment, there were minor and insignificant differences in mean SF-36 scores between patients and controls. Eight (n = 18) and 22% (n = 51) of the patients had low scores (- 2 SD of the control group) in the physical and mental dimensions of SF-36, respectively. Patients with low scores were usually male, single, on sick leave before admission to critical care, and survived shorter after being in ICU. After adjusting for age, sex, and coexisting conditions, mean HRQoL scores were almost equal in patients and controls. Up to 22% (n = 51) of the patients had however a poor quality of life as compared to the controls (-2 SD). This group, which more often consisted of singles, men, individuals who were on sick leave before admission to the ICU, had an increased mortality after ICU. This group should be a target for future support.Critical care (London, England) 10/2013; 17(5):R236. DOI:10.1186/cc13059
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ABSTRACT: Background and Objective Although the predictive ability of the Charlson Index, Elixhauser Index (EI), Chronic Disease Score (CDS), and Health-related Quality of Life Comorbidity Index (HRQL-CI) for health care outcomes has been assessed individually, little research has compared the discriminative performance of these indices directly in a single study. The current study compared these indices in discriminating among type 2 diabetes patients varying in demographics and health care outcomes characteristics.05/2011; 2(2). DOI:10.1016/j.ehrm.2011.06.002