Title | Multimorbidity in Medicare Beneficiaries: Performance of an ICD-Coded Multimorbidity-Weighted Index |
Publication Type | Journal Article |
Year of Publication | 2020 |
Authors | Wei, MY, Ratz, D, Mukamal, KJ |
Journal | Journal of the American Geriatrics Society |
Volume | n/a |
Keywords | administrative claims data, Comorbidity, Medicare, multimorbidity, physical functioning |
Abstract | OBJECTIVES Most older adults have multimorbidity that impairs physical functioning, but it is difficult to quantify using claims data. We previously developed and validated a multimorbidity-weighted index (MWI) that embeds physical functioning through disease weightings. We mapped these conditions to International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes and compared them with existing indices. DESIGN Population-based prospective cohort. SETTING Respondents to the 2006-2016 waves of the Health and Retirement Study (HRS) with linked Medicare claims data and continuous enrollment in 2006. PARTICIPANTS Community-dwelling Medicare-eligible HRS participants (N = 9923; mean age = 75.5 ± 8.5 y). MEASUREMENTS Individuals were followed for future physical functioning (2006-2014) and mortality (2007-2016). MWI conditions were mapped to ICD-9-CM codes to produce an ICD-coded MWI (MWI-ICD). We compared MWI-ICD, simple disease count, Charlson, Elixhauser, and the health-related quality of life comorbidity index (HRQOL-CI) through distributions, hazard ratios for mortality, and relationships with future physical functioning. RESULTS MWI-ICD exhibited the broadest distribution and most unique values (5891). Left censoring was most pronounced for Charlson (34.3% score = 0) and Elixhauser (13.1% score = 0) vs MWI (5.0% score = 0). Hazard ratios and concordance (C)-statistics for mortality across extreme quartiles were similar for MWI-ICD, Elixhauser, and Charlson but lower for disease count and the HRQOL-CI. For physical functioning, MWI-ICD yielded the greatest contrast across extreme quartiles and overall coefficient of determination (R2). CONCLUSION MWI-ICD was significantly associated with mortality and future physical functioning and comparable with established metrics for mortality prediction although not weighted to mortality. MWI-ICD successfully captures diseases accumulation and functioning in claims data. |
URL | https://onlinelibrary.wiley.com/doi/abs/10.1111/jgs.16310 |
DOI | 10.1111/jgs.16310 |
Citation Key | doi:10.1111/jgs.16310 |