Melissa Dattalo, Eva H. DuGoff, Katie Ronk, Korey A. Kennelty, Andrea L. Gilmore Bykovskyi, Amy J. Kind
Objectives To determine the extent of agreement between four commonly used definitions of multiple chronic conditions (MCCs) 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 MCCs (odds ratio (OR) = 1.50, 95% confidence interval (CI) = 1.47–1.52), Charlson Comorbidity Index–defined MCCs (OR = 1.45, 95% CI = 1.42–1.47), ACG-defined MCCs (OR = 1.22, 95% CI = 1.19–1.25), and CCW-defined MCCs (OR = 1.15, 95% CI = 1.11–1.19) than for those without MCCs.
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.
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