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Development and Validation of a Mortality Risk-Adjustment Model for Patients Hospitalized for Exacerbations of Chronic Obstructive Pulmonary Disease

Tabak, Ying P. PhD*; Sun, Xiaowu PhD*; Johannes, Richard S. MD, MS*,†,‡; Hyde, Linda BS, RHIA*; Shorr, Andrew F. MD, MPH§; Lindenauer, Peter K. MD, MSc∥,¶

doi: 10.1097/MLR.0b013e3182901982
Original Articles

Background: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a leading cause of hospitalization and death. We sought to develop and validate a mortality risk-adjustment model to enhance hospital performance measurement and to support comparative effectiveness research.

Methods: Using a derivation cohort of 69,299 AECOPD admissions in 2005–2006 across 172 hospitals, we developed a logistic regression model with age, sex, laboratory results, vital signs, and secondary diagnosis-based comorbidities as covariates. We converted the model coefficients into a score system and validated it using 33,327 admissions from 2007. We used the c-statistic to assess model fit.

Results: In the derivation and validation cohorts, the median (interquartile range) age was 72 (range, 63–79) versus 71 (range, 62–79) years; 45.6% versus 45.9% were male; and in-hospital mortality rates were 3.2% versus 2.9%, respectively. The predicted probability of deaths for individuals ranged from 0.004 to 0.942 versus 0.001 to 0.933, respectively. The relative contribution of variables to the predictive ability of the derivation model was age (18.3%), admission laboratory results (39.9%), vital signs (14.7%), altered mental status (7.1%), and comorbidities (19.9%). The model c-statistic was 0.83 (95% CI: 0.82, 0.84) versus 0.84 (95% CI: 0.83, 0.85), respectively, with good calibration for both cohorts.

Conclusions: A mortality prediction model combining clinical and administrative data that can be obtained from electronic health records demonstrated good discrimination among patients hospitalized for AECOPD. The addition of admission vital signs and laboratory results enhanced clinical validity and could be applied to future comparative effectiveness research and hospital profiling efforts.

Supplemental Digital Content is available in the text.

*Clinical Research, CareFusion, San Diego, CA

Harvard Medical School

Brigham and Women’s Hospital, Boston, MA

§Pulmonary and Critical Care, Washington Hospital Center, Washington, DC

Center for Quality of Care Research, Baystate Medical Center, Springfield, MA

Tufts University School of Medicine, Boston, MA

Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website,

The preliminary model was presented at a podium presentation at the Annual Research Meeting of Academy Health, June 2012, Orlando, FL.

Y.P.T., X.S., and R.S.J. are employees of CareFusion. L.H. was a former employee of CareFusion. The remaining authors declare no conflict of interest.

Reprints: Peter K. Lindenauer, MD, MSc, Center for Quality of Care Research, Baystate Medical Center, 280 Chestnut St, Third Floor, Springfield, MA 01199. E-mail:

© 2013 by Lippincott Williams & Wilkins.