Institute for Health Outcomes and Policy, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
Duquesne University School of Pharmacy, Pittsburgh, Pennsylvania, USA.
J Gastroenterol Hepatol. 2019 Jul;34(7):1222-1230. doi: 10.1111/jgh.14531. Epub 2018 Nov 22.
Patients with liver cirrhosis are impacted by comorbidities that affect healthcare utilization and survival. The study objective was to assess the relationship between a cirrhosis-specific comorbidity scoring system (CirCom) and healthcare utilization among patients with cirrhosis.
A retrospective cohort analysis was conducted using electronic medical records from a large academic-based healthcare network. Patients aged 18-90 years with at least one International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code for cirrhosis (571.2/571.5) between 2009 and 2014, and at least 180 pre-index and 365 days of post-index electronic medical record data were included. Patients were assigned CirCom scores based on comorbidities observed at/before index cirrhosis diagnosis. All-cause/cirrhosis-specific outpatient/hospital utilization was assessed post-index diagnosis across 1 year. Predictors of utilization (age, sex, race, body mass index, etiology, Model for End-stage Liver Disease, and CirCom) were assessed using negative binomial and Poisson regression with robust standard errors.
A total of 957 patients were included. Healthcare utilization according to CirCom demonstrated a positive linear relationship for both all-cause outpatient/hospital utilization, but no relationship was evident for cirrhosis-specific utilization. Increased CirCom was associated with an increased risk of all-cause utilization for both outpatient (relative risk [RR]: 1.75; 95% confidence interval [CI]: 1.47-2.07) and hospital (RR: 1.71; 95% CI: 1.38-2.12) utilization. However, CirCom showed a statistically non-significant association for cirrhosis-specific outpatient (RR: 1.08; 95% CI: 0.91-1.29) and cirrhosis-specific hospital (RR: 0.87, 95% CI: 0.67-1.13) utilization.
CirCom failed to predict cirrhosis-specific healthcare utilization but did positively predict all-cause utilization for both outpatient and hospital services and therefore may be useful in risk assessment and management of cirrhosis.
肝硬化患者常合并多种疾病，这会影响其医疗保健的利用和生存。本研究旨在评估肝硬化特异性合并症评分系统（CirCom）与肝硬化患者医疗保健利用之间的关系。
采用回顾性队列分析方法，利用大型学术医疗网络的电子病历数据。纳入标准为：2009 年至 2014 年期间至少有一次国际疾病分类，第 9 次修订版临床修正诊断代码（571.2/571.5）为肝硬化的 18-90 岁患者，且在索引肝硬化诊断前至少有 180 天的预索引和 365 天的电子病历数据。根据索引前肝硬化诊断时/之前观察到的合并症，为患者分配 CirCom 评分。在索引诊断后 1 年内，评估所有原因/肝硬化特异性门诊/住院利用情况。使用负二项式和泊松回归（采用稳健标准误差）评估利用的预测因素（年龄、性别、种族、体重指数、病因、终末期肝病模型和 CirCom）。
共纳入 957 例患者。根据 CirCom 的医疗保健利用情况显示，全因门诊/住院利用呈正线性关系，但肝硬化特异性利用则没有关系。CirCom 增加与全因门诊（相对风险 [RR]：1.75；95%置信区间 [CI]：1.47-2.07）和住院（RR：1.71；95% CI：1.38-2.12）利用的风险增加相关。然而，CirCom 与肝硬化特异性门诊（RR：1.08；95% CI：0.91-1.29）和肝硬化特异性住院（RR：0.87，95% CI：0.67-1.13）利用的相关性无统计学意义。
CirCom 未能预测肝硬化特异性医疗保健利用，但确实对门诊和住院服务的全因利用呈正相关，因此可能有助于评估和管理肝硬化。
