Abstract
BackgroundThe search for a reliable, valid and cost-effective comorbidity risk adjustment method for outcomes research continues to be a challenge. The most widely used tool, the Charlson Comorbidity Index (CCI) is limited due to frequent missing data in medical records and administrative data. Patient self-report data has the potential to be more complete but has not been widely used. The purpose of this study was to evaluate the performance of the Self-Administered Comorbidity Questionnaire (SCQ) to predict functional capacity, quality of life (QOL) health outcomes compared to CCI medical records data.MethodAn SCQ-score was generated from patient interview, and the CCI score was generated by medical record review for 525 patients hospitalized for Acute Coronary Syndrome (ACS) at baseline, three months and eight months post-discharge. Linear regression models assessed the extent to which there were differences in the ability of comorbidity measures to predict functional capacity (Activity Status Index [ASI] scores) and quality of life (EuroQOL 5D [EQ5D] scores).ResultsThe CCI (R2 = 0.245; p = 0.132) did not predict quality of life scores while the SCQ self-report method (R2 = 0.265; p < 0.0005) predicted the EQ5D scores. However, the CCI was almost as good as the SCQ for predicting the ASI scores at three and six months and performed slightly better in predicting ASI at eight-month follow up (R2 = 0.370; p < 0.0005 vs. R2 = 0.358; p < 0.0005) respectively. Only age, gender, family income and Center for Epidemiologic Studies-Depression (CESD) scores showed significant association with both measures in predicting QOL and functional capacity.ConclusionsAlthough our model R-squares were fairly low, these results show that the self-report SCQ index is a good alternative method to predict QOL health outcomes when compared to a CCI medical record score. Both measures predicted physical functioning similarly. This suggests that patient self-reported comorbidity data can be used for predicting physical functional capacity and QOL and can serve as a reliable risk adjustment measure. Self-report comorbidity data may provide a cost-effective alternative method for risk adjustment in clinical research, health policy and organizational improvement analyses.Trial registrationClinical Trials.gov NCT00416026
Highlights
The search for a reliable, valid and cost-effective comorbidity risk adjustment method for outcomes research continues to be a challenge
Conclusions: our model R-squares were fairly low, these results show that the self-report Self-Administered Comorbidity Questionnaire (SCQ) index is a good alternative method to predict quality of life (QOL) health outcomes when compared to a Charlson Comorbidity Index (CCI) medical record score
Both measures predicted physical functioning. This suggests that patient self-reported comorbidity data can be used for predicting physical functional capacity and QOL and can serve as a reliable risk adjustment measure
Summary
The search for a reliable, valid and cost-effective comorbidity risk adjustment method for outcomes research continues to be a challenge. [4,5,6,7] As part of a larger study of chronic disease self-management over eight months post-hospitalization for acute coronary syndrome (ACS), we sought to evaluate a self report comorbidity measure that would minimize the need to access medical records while maintaining predictive validity as reflected in the association with functional capacity and quality of life. Evaluating interventions in patient populations with chronic conditions frequently requires attention to comorbidity risk adjustment when examining global outcome measures such as functional capacity, health status and emotional well-being [2]. [10,11] Charlson et al [10] initially used multivariate analysis to develop a weighted comorbidity index designed to predict oneyear mortality This index was initially tested on a sample of medical hospital inpatients and later validated on a test population of breast cancer patients at another acute care facility. Medical record notes may frequently contain elements of both patient self-report and earlier professional documentation, sometimes offering a hybrid source of original data [15,16,18]
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