Elixhauser A, Steiner C, Harris D R, Coffey R M
MEDTAP International, Inc., Bethesda, MD 20814, USA.
Med Care. 1998 Jan;36(1):8-27. doi: 10.1097/00005650-199801000-00004.
This study attempts to develop a comprehensive set of comorbidity measures for use with large administrative inpatient datasets.
The study involved clinical and empirical review of comorbidity measures, development of a framework that attempts to segregate comorbidities from other aspects of the patient's condition, development of a comorbidity algorithm, and testing on heterogeneous and homogeneous patient groups. Data were drawn from all adult, nonmaternal inpatients from 438 acute care hospitals in California in 1992 (n = 1,779,167). Outcome measures were those commonly available in administrative data: length of stay, hospital charges, and in-hospital death.
A comprehensive set of 30 comorbidity measures was developed. The comorbidities were associated with substantial increases in length of stay, hospital charges, and mortality both for heterogeneous and homogeneous disease groups. Several comorbidities are described that are important predictors of outcomes, yet commonly are not measured. These include mental disorders, drug and alcohol abuse, obesity, coagulopathy, weight loss, and fluid and electrolyte disorders.
The comorbidities had independent effects on outcomes and probably should not be simplified as an index because they affect outcomes differently among different patient groups. The present method addresses some of the limitations of previous measures. It is based on a comprehensive approach to identifying comorbidities and separates them from the primary reason for hospitalization, resulting in an expanded set of comorbidities that easily is applied without further refinement to administrative data for a wide range of diseases.
本研究试图开发一套全面的合并症测量方法，用于大型住院患者管理数据集。
该研究包括对合并症测量方法进行临床和实证审查，构建一个试图将合并症与患者病情其他方面区分开来的框架，开发一种合并症算法，并在异质性和同质性患者群体上进行测试。数据取自1992年加利福尼亚州438家急性护理医院的所有成年非孕产妇住院患者（n = 1,779,167）。结局指标为管理数据中常见的指标：住院时间、住院费用和院内死亡。
开发出一套全面的30种合并症测量方法。对于异质性和同质性疾病组，合并症均与住院时间、住院费用和死亡率的大幅增加相关。描述了几种对结局有重要预测作用但通常未被测量的合并症。这些包括精神障碍、药物和酒精滥用、肥胖、凝血障碍、体重减轻以及液体和电解质紊乱。
合并症对结局有独立影响，可能不应简化为一个指数，因为它们在不同患者群体中对结局的影响不同。本方法解决了先前测量方法的一些局限性。它基于一种全面识别合并症的方法，并将其与住院的主要原因区分开来，从而产生了一组扩展的合并症，可轻松应用于广泛疾病的管理数据，无需进一步细化。
