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Developing a claim-based version of the ACE-27 comorbidity index: a comparison with medical record review.

Publication ,  Journal Article
Fleming, ST; Sabatino, SA; Kimmick, G; Cress, R; Wu, X-C; Trentham-Dietz, A; Huang, B; Hwang, W; Liff, J
Published in: Med Care
August 2011

OBJECTIVES: The adult comorbidity evaluation (ACE-27) is a medical record-based comorbidity index that predicts survival among various types of cancer patients. The purpose of this study was to compare the medical record-based ACE-27 instrument to a newly developed administrative claim-based ACE-27 measure. STUDY DESIGN AND SETTING: Cross-sectional study of 4,300 breast and prostate cancer patients from the Centers for Disease Control and Prevention Patterns of Care Study. RESULTS: Comorbidities with the highest concordance were diabetes (sensitivity=84.6%, κ=0.58 for breast cancer patients; sensitivity=0.764, κ=0.54 for prostate cancer patients), and hypertension (sensitivity=78.5%, κ=0.32 for breast cancer patients; sensitivity=69.6%, κ=0.28 for prostate cancer patients). Diseases with fair or moderate agreement in one or both cancer sites include congestive heart failure, arrhythmia, hypertension, respiratory diseases, hepatic disease, renal disease, dementia, and neuromuscular disease. For overall indices, agreement was fair but with high sensitivities in the collapsed indices, and the highest sensitivities in the lowest level of decompensation. CONCLUSIONS: The ACE-27 comorbidity score derived from administrative claims data provides a tool to examine the relationship between comorbidity, cancer diagnosis, and outcomes in future epidemiologic research, particularly when medical record review is logistically impossible. The classification of most comorbidities into 2 or 3 levels of severity within a claim-based measure is a major development. Future research should be directed toward refining the measure with a longer review period or different paradigms for diagnosis identification, and testing the predictive ability of the measure in terms of survival, complications, or other outcomes of care.

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Published In

Med Care

DOI

EISSN

1537-1948

Publication Date

August 2011

Volume

49

Issue

8

Start / End Page

752 / 760

Location

United States

Related Subject Headings

  • Survival Analysis
  • Sensitivity and Specificity
  • Registries
  • Prostatic Neoplasms
  • Prevalence
  • Predictive Value of Tests
  • Middle Aged
  • Medical Records
  • Male
  • Hypertension
 

Citation

APA
Chicago
ICMJE
MLA
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Fleming, S. T., Sabatino, S. A., Kimmick, G., Cress, R., Wu, X.-C., Trentham-Dietz, A., … Liff, J. (2011). Developing a claim-based version of the ACE-27 comorbidity index: a comparison with medical record review. Med Care, 49(8), 752–760. https://doi.org/10.1097/MLR.0b013e318215d7dd
Fleming, Steven T., Susan A. Sabatino, Gretchen Kimmick, Rosemary Cress, Xiao-Cheng Wu, Amy Trentham-Dietz, Bin Huang, Wenke Hwang, and Jonathan Liff. “Developing a claim-based version of the ACE-27 comorbidity index: a comparison with medical record review.Med Care 49, no. 8 (August 2011): 752–60. https://doi.org/10.1097/MLR.0b013e318215d7dd.
Fleming ST, Sabatino SA, Kimmick G, Cress R, Wu X-C, Trentham-Dietz A, et al. Developing a claim-based version of the ACE-27 comorbidity index: a comparison with medical record review. Med Care. 2011 Aug;49(8):752–60.
Fleming, Steven T., et al. “Developing a claim-based version of the ACE-27 comorbidity index: a comparison with medical record review.Med Care, vol. 49, no. 8, Aug. 2011, pp. 752–60. Pubmed, doi:10.1097/MLR.0b013e318215d7dd.
Fleming ST, Sabatino SA, Kimmick G, Cress R, Wu X-C, Trentham-Dietz A, Huang B, Hwang W, Liff J. Developing a claim-based version of the ACE-27 comorbidity index: a comparison with medical record review. Med Care. 2011 Aug;49(8):752–760.

Published In

Med Care

DOI

EISSN

1537-1948

Publication Date

August 2011

Volume

49

Issue

8

Start / End Page

752 / 760

Location

United States

Related Subject Headings

  • Survival Analysis
  • Sensitivity and Specificity
  • Registries
  • Prostatic Neoplasms
  • Prevalence
  • Predictive Value of Tests
  • Middle Aged
  • Medical Records
  • Male
  • Hypertension