Abstract
BackgroundThe Functional Comorbidity Index (FCI) was recently developed to predict physical function in acute lung injury patients using comorbidity data. Our objectives were to determine: (1) the inter-rater reliability of the FCI collected using in-patient discharge summaries (primary objective); and (2) the accuracy and predictive validity of the FCI collected using hospital discharge summaries and admission records versus complete chart review (secondary objectives).MethodsFor reliability, we evaluated the FCI’s intraclass correlation coefficient (ICC) among trained research staff performing data collection for 421 acute lung injury patients enrolled in a prospective cohort study. For validity and accuracy, we compared the detection of FCI comorbidities across three types of inpatient medical records, and the association of the respective FCI scores obtained with patients’ SF-36 physical function subscale (PFS) scores at 1-year follow-up.ResultsInter-rater reliability was near-perfect (ICC 0.91; 95% CI 0.89-0.94). Hospital admission records and discharge summaries (vs. complete chart review) significantly underestimated the total FCI score. However, using multivariable linear regression, FCI scores collected using each of the three types of inpatient medical records had similar associations with PFS, suggesting similar predictive value.ConclusionsData collection using in-patient discharge summaries represents a reliable and valid method for collecting FCI comorbidity information.
Highlights
The Functional Comorbidity Index (FCI) was recently developed to predict physical function in acute lung injury patients using comorbidity data
We compared the predictive validity of the total FCI score, obtained by each of the three data collection methods, by comparing the association between each FCI score and Short-Form 36 (SF-36) physical function subscale (PFS) score at 1 year. To contrast with these findings regarding the FCI, we evaluated the predictive validity of the Charlson Comorbidity Index (CCI) [13] and the chronic health points comorbidity measure of the Acute Physiology and Chronic Health Evaluation (APACHE) II score [14] for SF-36 PFS score at 1 year
We evaluated the amount of variance explained in SF-36 PFS score at 1 year with models using CCI and chronic health points comorbidity measure of the APACHE II score instead of FCI
Summary
The Functional Comorbidity Index (FCI) was recently developed to predict physical function in acute lung injury patients using comorbidity data. Rather than reviewing the entire medical record, researchers may collect comorbidity data using two alternative methods: (1) prospective collection from hospital admission records available at the time of patient enrollment, or (2) retrospective collection based on patients’ hospital discharge summary. The latter option is attractive because these discharge summaries are frequently available electronically avoiding the need for review of paper-based medical charts. For these two data collection methods to be useful for clinical research, they must introduce minimal bias in the measurement of comorbidity
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