Comparison of Comorbidity Measures - Input Data

Quality

Bruce W. Morlan, Kandace Lackore

June 10, 2010
Abstract
Background. Comorbidity measures are commonly used in health care research
to correct outcomes for the patients

S overall health. Three common measures are

the CHADS2 score (risk of stroke), the Charlson score (overall risk of death) and the
Elixhauser score (also overall risk of death). Getting valid comorbidity data on large
numbers of patients requires either intensive and expensive manual review of patient
records or a trusted automated data retrieval system. Mayo Clinic uses two SAS macros
to automatically extract data and compute comorbidity, one for computing Charlson
score and the other for computing Elixhauser score. This project looked at the input
data as generated by manual methods and compared those data with data produced
automatically using those two implementations. Methods. We obtained CHADS2
markers from a manual extraction for patients with ECGs as part of a research project
on atrial brillation. We then ran those patients through the two macros to obtain the
associated markers, then compared those markers between the three methods. Risks
were computed and the predictions were compared. Results. The two measures do not
appear at rst to be very concordant, but the computed risks are more similar.
Contents
1 Background 2
2 Methodology 2

Analysis was run Mon Jun 7 15:10:48 2010

1
Mayo Clinic Comparison of Comorbidity Measures HCPR
3 Results 3
3.1 Comparing the three using common features . . . . . . . . . . . . . . . . . . 3
A The clinical data used in the comorbidities 6
A.1 Elixhauser Code Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
A.2 Charlson Code Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
A.3 Comparing Charlson DXCODES with Elixhauser DXCODES . . . . . . . . . . . . 9
1 Background
Comorbidity measures are computed from patient characteristic in an eort to predict out-
comes. They are often used to correct for patient condition when analyzing treatment eects.
Adding comorbidity to the model removes some of the eects of the comorbidities. [? 2].
Charlson and Elixhauser are often used and often cited and have been compared in the
literature. (Ref: [3, 1])
2 Methodology
A Mayo Wisdom Lab project generated a set of patients with known CHADS2 comorbidities
for a project that was looking at ECGs and detecting and notifying atrial brillation. Because
some of the CHADS2 markers are also used in the Charlson and Elixhauser comorbidity
scores it was possible to contrast the manual, clinical notes review based ndings for those
shared markers with the markers returned by Mayos SAS macros. We used the clinic IDs
and the date of the ECG as the reference date when calling the SAS macros as the manual
assessment was done as of the date of the ECG.
All three methods can be compared for two of the markers (Diabetes and Congestive Heart
Failure (CHF)), but the other two markers (Stroke, Hypertension) were only shared by two
of the three measures.
The conditions are extracted from the medical records using DXCODES matched to the features
required (see A). This mapping may use up to several hundred DXCODES to identify a single
condition. These conditions are then used to compute the comorbidity score using weights as
taken from the literature. Two patients are dropped for lack of any data. Patient conditions
are either Yes the condition was present or No, the condition was not present.
morlan.bruce@mayo.edu 2 June 10, 2010
Mayo Clinic Comparison of Comorbidity Measures HCPR
3 Results
3.1 Comparing the three using common features
How well do the features shared between the three compare? There are 4 variables shared
across at least two of the 3 comorbidities (AFF, Charlson, Elixhauser) we looked at.
AFF Charlson Elixhauser
Diabetes Diabetes Charlson Diabetes Elix dm Elix dmcx
Stroke Stroke Charlson Cerebrovasc
Hypertension Hypertension Elix htncx Elix htn c
CHF CHF Charlson CHF Elix chf
Table 1: The common elements among the comorbidities
The basic features in each are summarized in the following tables. In each table we compare
the counts for each of the values for the rst source with the counts for the variables for the
second.
Note that the . as used in the manual (AFF) data is usually equivalent to the 0 as used in
the macro reports.
0 1 Total
0 123.00 20.00 143.00
1 4.00 19.00 23.00
Total 127.00 39.00 166.00
Table 2: Diabetes: Diabetes (AFF) vs Charlson Diabetes(Charlson)
0 1 Total
0 138.00 5.00 143.00
1 12.00 11.00 23.00
Total 150.00 16.00 166.00
Table 3: Diabetes: Diabetes (AFF) vs Elix dm(Elixhauser)
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Mayo Clinic Comparison of Comorbidity Measures HCPR
0 1 Total
0 142.00 1.00 143.00
1 18.00 5.00 23.00
Total 160.00 6.00 166.00
Table 4: Diabetes: Diabetes (AFF) vs Elix dmcx(Elixhauser)
0 1 Total
0 127.00 0.00 127.00
1 23.00 16.00 39.00
Total 150.00 16.00 166.00
Table 5: Diabetes: Charlson Diabetes(Charlson) vs Elix dm(Elixhauser)
0 1 Total
0 127.00 0.00 127.00
1 33.00 6.00 39.00
Total 160.00 6.00 166.00
Table 6: Diabetes: Charlson Diabetes(Charlson) vs Elix dmcx(Elixhauser)
0 1 Total
0 141.00 14.00 155.00
1 5.00 6.00 11.00
Total 146.00 20.00 166.00
Table 7: Stroke: Stroke(AFF) vs Charlson Cerebrovasc(Charlson)
0 1 Total
0 110.00 1.00 111.00
1 50.00 5.00 55.00
Total 160.00 6.00 166.00
Table 8: Hypertension: Hypertension(AFF) vs Elix htncx(Elixhauser)
0 1 Total
0 91.00 20.00 111.00
1 32.00 23.00 55.00
Total 123.00 43.00 166.00
Table 9: Hypertension: Hypertension(AFF) vs Elix htn c(Elixhauser)
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0 1 Total
0 123.00 31.00 154.00
1 1.00 11.00 12.00
Total 124.00 42.00 166.00
Table 10: CHF: CHF(AFF) vs Charlson CHF(Charlson)
0 1 Total
0 136.00 18.00 154.00
1 4.00 8.00 12.00
Total 140.00 26.00 166.00
Table 11: CHF: CHF(AFF) vs Elix chf(Elixhauser)
0 1 Total
0 124.00 0.00 124.00
1 16.00 26.00 42.00
Total 140.00 26.00 166.00
Table 12: CHF: Charlson CHF(Charlson) vs Elix chf(Elixhauser)
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Mayo Clinic Comparison of Comorbidity Measures HCPR
A The clinical data used in the comorbidities
The primary data-base entities used in the respective comorbidity measures are as shown.
In Table 13 we show the conditions both as their short variable name form and their
description. Also shown are the numbers of DXCODEs mapped to each of the conditions.
Similarly, in Table 14 we see the information for the Charlson score.
A.1 Elixhauser Code Summary
morlan.bruce@mayo.edu 6 June 10, 2010
Mayo Clinic Comparison of Comorbidity Measures HCPR
Condition Description Number of DXCODEs
AIDS HIV and AIDS 13
ALCOHOL ALCOHOL 22
ANEMDEF Deciency anemias 7
ARTH Rheumatoid arthritis/collagen vascular
diseases
28
BLDLOSS Blood loss anemia 6
CHF Congestive Heart Failure 19
CHRNLUNG Chronic Pulmonary Disease 53
COAG Coagulations Deciency 24
DEPRESS Depression 5
DM Diabetes w/out chornic complications 35
DMCX Diabetes with chronic complications 47
DRUG Drug Abuse 101
HHRWCHF Hypertensive heart and renal disease
with heart failure
3
HHRWHRF Hypertensive heart and renal disease
with heart and renal failure
3
HHRWOHRF Hypertensive heart and renal disease
w/out heart or renal failure
3
HHRWRF Hypertensive heart and renal disease
with renal failure
3
HRENWORF Hypertensive renal disease without re-
nal failure
11
HRENWRF Hypertensive renal disease with renal
failure
3
HTN Hypertension Uncomplicated 7
HTNCX Hypertension Complicated 2
HTNPREG Pre-existing hypertension complicating
pregnancy
5
HTNWCHF Hypertensive heart disease with heart
failure
3
HTNWOCHF Hypertensive heart disease w/out heart
failure
6
HYPOTHY Hypothyroidism 7
LIVER Liver Disease 24
LYMPH Lymphoma 273
LYTES Fluid and electrolyte disorders 13
METS Metastatic Cancer 33
NEURO Other neurological 102
OBESE Obesity 21
OHTNPREG Other hypertension in pregnancy 10
PARA Paralysis 66
PERIVASC Peripheral Vascular Disorder 58
PSYCH Psychoses 153
PULMCIRC Pulmonary Circulation Disorder 9
RENLFAIL Renal Failure 17
TUMOR Solid tumor without metastasis 146
ULCER Chronic Peptic ulcer disease 24
VALV Valvular Disease 37
WGHTLOSS Weight Loss 11
Table 13: Elixhauser Variables Descriptions
morlan.bruce@mayo.edu 7 June 10, 2010
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A.2 Charlson Code Summary
Condition Description Number of DXCODEs
AIDS HIV and AIDS 14
ARTH Rhreumatologic 8
CHF Congestive Heart Failure 29
CVASC Cerebrial Vascular Disease 22
DEM Dementia 34
DM Diabetes 36
DMCX Diabetes with Chronic Complications 15
LIVER Mild Liver Disease 19
MALIG Any Malignancy 737
METS Metastatic Solid Tumor 34
MI Myocardial Infarction 42
PARA Paraplagia 42
PULM Chronic Pulmonary Disease 52
RENAL Renal Disease 32
ULCER Peptic Ulcer 112
VASC Peripheral Vascular Disease 59
Table 14: Charlson Conditions and Descriptions
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Mayo Clinic Comparison of Comorbidity Measures HCPR
A.3 Comparing Charlson DXCODES with Elixhauser DXCODES
Using DXCODES extracted from the macro we compare the two comorbidities mappings. The
number in each location represents the number of DXCODES shared between the two measures.
Note that there are codes assigned in each that are not matched in the other (see <not
matched> row and column of table). Results are summarized in Table 15.
References
[1] Bing Li, Dewey Evans, Peter Faris, Staord Dean, and Hude Quan. Risk adjustment
performance of charlson and elixhauser comorbidities in icd-9 and icd-10 administrative
databases. BMC Health Services Research, 8(1):12, 2008.
[2] Deborah Peikes, Arnold Chen, Jennifer Schore, and Randall Brown. Eects of Care
Coordination on Hospitalization, Quality of Care, and Health Care Expenditures Among
Medicare Beneciaries: 15 Randomized Trials. JAMA, 301(6):603618, 2009.
[3] DA Southern, H Quan, and WA Ghali. Comparison of the elixhauser and charlson/deyo
methods of comorbidity measurement in administrative data. Med Care., 42(4):35560,
April 2004.
morlan.bruce@mayo.edu 9 June 10, 2010
Mayo Clinic Comparison of Comorbidity Measures HCPR
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AIDS 13 . . . . . . . . . . . . . . . . 13
ALCOHOL . . . . . . . . . . . . . . . . 22 22
ANEMDEF . . . . . . . . . . . . . . . . 7 7
ARTH . 7 . . . . . . . . . . . . . . 21 28
BLDLOSS . . . . . . . . . . . . . . . . 6 6
CHF . . 18 . . . . . . . . . . . . . 1 19
CHRNLUNG . . . . . . . . . . . . 48 . . . 5 53
COAG . . . . . . . . . . . . . . . . 24 24
DEPRESS . . . . . . . . . . . . . . . . 5 5
DM . . . . . 19 . . . . . . . . . . 16 35
DMCX . . . . . 15 13 . . . . . . . . . 19 47
DRUG . . . . . . . . . . . . . . . . 101 101
HHRWCHF . . . . . . . . . . . . . . . . 3 3
HHRWHRF . . . . . . . . . . . . . . . . 3 3
HHRWOHRF . . . . . . . . . . . . . . . . 3 3
HHRWRF . . . . . . . . . . . . . . . . 3 3
HRENWORF . . . . . . . . . . . . . . . . 11 11
HRENWRF . . . . . . . . . . . . . . . . 3 3
HTN . . . . . . . . . . . . . . . . 7 7
HTNCX . . . . . . . . . . . . . . . . 2 2
HTNPREG . . . . . . . . . . . . . . . . 5 5
HTNWCHF . . 3 . . . . . . . . . . . . . . 3
HTNWOCHF . . 3 . . . . . . . . . . . . . 3 6
HYPOTHY . . . . . . . . . . . . . . . . 7 7
LIVER . . . . . . . 13 . . . . . . . . 11 24
LYMPH . . . . . . . . 270 . . . . . . . 3 273
LYTES . . . . . . . . . . . . . . . . 13 13
METS . . . . . . . . . 30 . . . . . . 3 33
NEURO . . . . 16 . . . . . . . . . . . 86 102
OBESE . . . . . . . . . . . . . . . . 21 21
OHTNPREG . . . . . . . . . . . . . . . . 10 10
PARA . . . . . . . . . . . 39 . . . . 27 66
PERIVASC . . . . . . . . . . . . . . . 52 6 58
PSYCH . . . . . . . . . . . . . . . . 153 153
PULMCIRC . . . . . . . . . . . . . . . . 9 9
RENLFAIL . . . . . . . . . . . . . 6 . . 11 17
TUMOR . . . . . . . . 116 . . . . . . . 30 146
ULCER . . . . . . . . . . . . . . 24 . . 24
VALV . . . . . . . . . . . . . . . . 37 37
WGHTLOSS . . . . . . . . . . . . . . . . 11 11
<not matched> 1 1 5 22 18 2 2 6 351 4 42 3 4 26 88 7
Total 14 8 29 22 34 36 15 19 737 34 42 42 52 32 112 59
Table 15: Compare DXCODES between Charlson and Elixhauser
morlan.bruce@mayo.edu 10 June 10, 2010