Kieszak S M, Flanders W D, Kosinski A S, Shipp C C, Karp H
Kerr L. White Institute for Health Services Research, Decatur, Georgia 30030, USA.
J Clin Epidemiol. 1999 Feb;52(2):137-42. doi: 10.1016/s0895-4356(98)00154-1.
The objective of this article is to compare the Charlson comorbidity index derived from medical record data (Chart Index) with the same index derived from billing data (ICD-9 Index) to determine how well each predicted inpatient and 30-day mortality, length of stay, and complications among Medicare beneficiaries hospitalized for carotid endarterectomy. Economic and time constraints have increased the need for risk adjusters derived from administrative data, yet few studies have compared these measures with those derived from chart review. Using logistic regression, the Chart Index was found to be a significant predictor of inpatient mortality, 30-day mortality, length of stay, and complications, after controlling for age, gender, and neurologic and medical risk factors (P values = 0.004, 0.056, 0.0001, and 0.042, respectively). The ICD-9 Index approached significance as a predictor of the outcomes (P values = 0.092, 0.100, 0.093, and 0.080, respectively). The Chart Index was shown to be superior to the ICD-9 Index within this patient sample.
本文的目的是比较从病历数据得出的查尔森合并症指数（病历指数）与从计费数据得出的相同指数（ICD-9指数），以确定在因颈动脉内膜切除术住院的医疗保险受益人中，每种指数对住院患者及30天死亡率、住院时间和并发症的预测效果如何。经济和时间限制增加了对源自行政数据的风险调整指标的需求，但很少有研究将这些指标与病历审查得出的指标进行比较。通过逻辑回归分析发现，在控制了年龄、性别、神经和医疗风险因素后，病历指数是住院死亡率、30天死亡率、住院时间和并发症的显著预测指标（P值分别为0.004、0.056、0.0001和0.042）。ICD-9指数作为这些结果的预测指标接近显著水平（P值分别为0.092、0.100、0.093和0.080）。在该患者样本中，病历指数显示优于ICD-9指数。
