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Identifying Increased Risk of Readmission and In-hospital Mortality Using Hospital Administrative Data: The AHRQ Elixhauser Comorbidity Index

Moore, Brian J. PhD*; White, Susan PhD; Washington, Raynard PhD, MPH; Coenen, Natalia MPH§; Elixhauser, Anne PhD

doi: 10.1097/MLR.0000000000000735
Original Articles

Objective: We extend the literature on comorbidity measurement by developing 2 indices, based on the Elixhauser Comorbidity measures, designed to predict 2 frequently reported health outcomes: in-hospital mortality and 30-day readmission in administrative data. The Elixhauser measures are commonly used in research as an adjustment factor to control for severity of illness.

Data Sources: We used a large analysis file built from all-payer hospital administrative data in the Healthcare Cost and Utilization Project State Inpatient Databases from 18 states in 2011 and 2012.

Methods: The final models were derived with bootstrapped replications of backward stepwise logistic regressions on each outcome. Odds ratios and index weights were generated for each Elixhauser comorbidity to create a single index score per record for mortality and readmissions. Model validation was conducted with c-statistics.

Results: Our index scores performed as well as using all 29 Elixhauser comorbidity variables separately. The c-statistic for our index scores without inclusion of other covariates was 0.777 (95% confidence interval, 0.776–0.778) for the mortality index and 0.634 (95% confidence interval, 0.633–0.634) for the readmissions index. The indices were stable across multiple subsamples defined by demographic characteristics or clinical condition. The addition of other commonly used covariates (age, sex, expected payer) improved discrimination modestly.

Conclusions: These indices are effective methods to incorporate the influence of comorbid conditions in models designed to assess the risk of in-hospital mortality and readmission using administrative data with limited clinical information, especially when small samples sizes are an issue.

Supplemental Digital Content is available in the text.

*IBM Watson Health, Ann Arbor, MI

The Ohio State University, Columbus, OH

Department of Public Health, PA

§IBM Watson Health, Santa Barbara, CA

Agency for Healthcare Research and Quality, Center for Quality Improvement and Patient Safety, Rockville, MD

Supported by the Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project (HCUP).

The views expressed in this article are those of the authors and do not necessarily reflect those of the Agency for Healthcare Research and Quality or the US Department of Health and Human Services.

The authors declare no conflict of interest.

Reprints: Brian J. Moore, PhD, IBM Watson Health, 100 Phoenix Drive, Ann Arbor, MI 48108. E-mail: brian.moore@us.ibm.com.

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.