The central role of comorbidity in predicting ambulatory care sensitive hospitalizations.

Publisher: Oxford University Press Country of Publication: England NLM ID: 9204966 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1464-360X (Electronic) Linking ISSN: 11011262 NLM ISO Abbreviation: Eur J Public Health Subsets: MEDLINE

Publication: Oxford : Oxford University Press
Original Publication: Stockholm, Sweden : Almqvist & Wiksell International, c1991-

Comorbidity*; Ambulatory Care/*statistics & numerical data ; Hospitalization/*statistics & numerical data; Acute Disease/epidemiology ; Aged ; Aged, 80 and over ; Chronic Disease/epidemiology ; Female ; Health Services Accessibility/statistics & numerical data ; Humans ; Logistic Models ; Male ; Medicare/statistics & numerical data ; Models, Statistical ; Risk Factors ; United States/epidemiology

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.

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N01PC35136 United States CA NCI NIH HHS; R01 CA104935 United States CA NCI NIH HHS; 1 R01 CA104935 United States CA NCI NIH HHS

Date Created: 20130402 Date Completed: 20141020 Latest Revision: 20211021

20240628

PMC3901312

10.1093/eurpub/ckt019

23543676