Abstract:
OBJECTIVE:To compare the performances of 3 comorbidity indices, the Charlson Comorbidity Index, the Elixhauser Comorbidity Index, and the Centers for Medicare & Medicaid Services (CMS) risk adjustment model, Hierarchical Condition Category (HCC), in predicting post-acute discharge settings and hospital readmission for patients after joint replacement. METHODS:A retrospective study of Medicare beneficiaries with total knee replacement (TKR) or total hip replacement (THR) discharged from hospitals in 2009-2011 (n = 607,349) was performed. Study outcomes were post-acute discharge setting and unplanned 30-, 60-, and 90-day hospital readmissions. Logistic regression models were built to compare the performance of the 3 comorbidity indices using C statistics. The base model included patient demographics and hospital use. Subsequent models included 1 of the 3 comorbidity indices. Additional multivariable logistic regression models were built to identify individual comorbid conditions associated with high risk of hospital readmissions. RESULTS:The 30-, 60-, and 90-day unplanned hospital readmission rates were 5.3%, 7.2%, and 8.5%, respectively. Patients were most frequently discharged to home health (46.3%), followed by skilled nursing facility (40.9%) and inpatient rehabilitation facility (12.7%). The C statistics for the base model in predicting post-acute discharge setting and 30-, 60-, and 90-day readmission in TKR and THR were between 0.63 and 0.67. Adding the Charlson Comorbidity Index, the Elixhauser Comorbidity Index, or HCC increased the C statistic minimally from the base model for predicting both discharge settings and hospital readmission. The health conditions most frequently associated with hospital readmission were diabetes mellitus, pulmonary disease, arrhythmias, and heart disease. CONCLUSION:The comorbidity indices and CMS-HCC demonstrated weak discriminatory ability to predict post-acute discharge settings and hospital readmission following joint replacement.
journal_name
Arthritis Care Res (Hoboken)journal_title
Arthritis care & researchauthors
Kumar A,Karmarkar A,Downer B,Vashist A,Adhikari D,Al Snih S,Ottenbacher Kdoi
10.1002/acr.23195subject
Has Abstractpub_date
2017-11-01 00:00:00pages
1668-1675issue
11eissn
2151-464Xissn
2151-4658journal_volume
69pub_type
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journal_title:Arthritis care & research
pub_type: 杂志文章
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journal_title:Arthritis care & research
pub_type: 杂志文章
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journal_title:Arthritis care & research
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journal_title:Arthritis care & research
pub_type: 杂志文章,评审
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journal_title:Arthritis care & research
pub_type: 杂志文章,meta分析
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pub_type: 杂志文章,随机对照试验
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pub_type: 杂志文章,随机对照试验
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journal_title:Arthritis care & research
pub_type: 杂志文章
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pub_type: 临床试验,杂志文章
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journal_title:Arthritis care & research
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更新日期:2013-12-01 00:00:00
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journal_title:Arthritis care & research
pub_type: 杂志文章
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更新日期:2013-01-01 00:00:00
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pub_type: 杂志文章,多中心研究
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更新日期:2018-01-01 00:00:00
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journal_title:Arthritis care & research
pub_type: 杂志文章,多中心研究,随机对照试验
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更新日期:2018-05-01 00:00:00
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pub_type: 杂志文章
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更新日期:2017-05-01 00:00:00
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journal_title:Arthritis care & research
pub_type: 杂志文章
doi:10.1002/acr.22095
更新日期:2014-01-01 00:00:00
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journal_title:Arthritis care & research
pub_type: 杂志文章,多中心研究
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更新日期:2016-10-01 00:00:00
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更新日期:2018-08-01 00:00:00
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journal_title:Arthritis care & research
pub_type: 杂志文章
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更新日期:2020-12-18 00:00:00
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journal_title:Arthritis care & research
pub_type: 杂志文章
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pub_type: 杂志文章
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journal_title:Arthritis care & research
pub_type: 杂志文章,多中心研究
doi:10.1002/acr.21680
更新日期:2012-08-01 00:00:00
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pub_type: 杂志文章
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更新日期:2020-04-01 00:00:00