Skip to main content
Hauptrubriken
CME Facharzt-Training Webinare Zeitschriften Bücher e.Medpedia Podcast
Service
Jobbörse Info & Hilfe
Fachgebiete
Anästhesiologie Allgemeinmedizin Arbeitsmedizin Augenheilkunde Chirurgie Dermatologie Gynäkologie und Geburtshilfe HNO Innere Medizin Kardiologie Neurologie Onkologie und Hämatologie Orthopädie und Unfallchirurgie Pädiatrie Pathologie Psychiatrie Radiologie Rechtsmedizin Urologie Zahnmedizin
Themen
Klimawandel und Gesundheit Neues aus dem Markt COVID-19 Praxis und Beruf Seltene Erkrankungen GOÄ & EBM Panorama
Sammlungen
Kasuistiken Algorithmen & Infografiken Blickdiagnosen Arthropedia FlapFinder (für Dermatochirurgen) Videos Kongressberichterstattung Medizin für Apothekerinnen und Apotheker Für Ärztinnen und Ärzte in Weiterbildung Für Medizinstudierende
Erweiterte Suche
Anmelden
nach oben
Quality of Life Research
Erschienen in: Quality of Life Research 10/2016

30.04.2016

Refined comorbidity index based on dimensionality of comorbidity for use in studies of health-related quality of life

verfasst von: Huang-Tz Ou, Chung-Ying Lin, Steven R. Erickson, Rajesh Balkrishnan

Erschienen in: Quality of Life Research | Ausgabe 10/2016

Einloggen, um Zugang zu erhalten

Abstract

Purpose

To refine two subscales of the health-related quality of life comorbidity index (HRQoL-CI) into a single index measure.

Methods

The 2010 and 2012 Medical Expenditure Panel Surveys were utilized as development and validation datasets, respectively. The least absolute shrinkage and selection operator was applied to select important comorbidity candidates associated with HRQoL. Exploratory factor analysis and confirmatory factor analysis (CFA) were used to assess dimensionality in comorbidity. Statistical weights were derived based on standardized factor loadings from CFA and regression coefficients from the model predicting HRQoL. Prediction errors and model R2 values were compared between HRQoL-CI and Charlson CI (CCI).

Results

Eighteen comorbid conditions were identified. CFA models indicated that the second-order multidimensional comorbidity structure had a better fit to the data than did the first-order unidimensional structure. The predictive performance of the refined scale under a multidimensional structure utilizing statistical weights outperformed the original scale and CCI in terms of average prediction error and R2 in the prediction models (R2 values from refined scale model are 0.25, 0.30, and 0.28 versus those from CCI of 0.10, 0.09, and 0.06 for general health, SF-6D, and EQ-5D, respectively).

Conclusion

The dimensionality of comorbidity and the weight scheme significantly improved the performance of the refined HRQoL-CI. The refined single HRQoL-CI measure appears to be an appropriate and valid instrument specific for risk adjustment in studies of HRQoL. Future research that validates the refined scales for different cultures, age groups, and healthcare settings is warranted.
Anhänge
Nur mit Berechtigung zugänglich
Literatur
1.
Wu, S. Y., & Green, A. (2000). Projection of chronic illness prevalence and cost inflation. Washington, DC: RAND Health.
2.
van den Akker, M., Buntinx, F., Metsemakers, J. F., Roos, S., & Knottnerus, J. A. (1998). Multimorbidity in general practice: Prevalence, incidence, and determinants of co-occurring chronic and recurrent diseases. Journal of Clinical Epidemiology, 51(5), 367–375.CrossRefPubMed
3.
Knottnerus, J. A., Metsemakers, J., Hoppener, P., & Limonard, C. (1992). Chronic illness in the community and the concept of ‘social prevalence’. Family Practice, 9(1), 15–21.CrossRefPubMed
4.
Schellevis, F. G., van der Velden, J., van de Lisdonk, E., van Eijk, J. T., & van Weel, C. (1993). Comorbidity of chronic diseases in general practice. Journal of Clinical Epidemiology, 46(5), 469–473.CrossRefPubMed
5.
Metsemakers, J. F., Hoppener, P., Knottnerus, J. A., Kocken, R. J., & Limonard, C. B. (1992). Computerized health information in The Netherlands: A registration network of family practices. British Journal of General Practice, 42(356), 102–106.PubMedPubMedCentral
6.
Wolff, J. L., Starfield, B., & Anderson, G. (2002). Prevalence, expenditures, and complications of multiple chronic conditions in the elderly. Archives of Internal Medicine, 162(20), 2269–2276.CrossRefPubMed
7.
Jones, C. A., Voaklander, D. C., Johnston, D. W., & Suarez-Almazor, M. E. (2000). Health related quality of life outcomes after total hip and knee arthroplasties in a community based population. The Journal of rheumatology, 27(7), 1745–1752.PubMed
8.
Jones, C. A., Voaklander, D. C., Johnston, D. W., & Suarez-Almazor, M. E. (2001). The effect of age on pain, function, and quality of life after total hip and knee arthroplasty. Archives of Internal Medicine, 161(3), 454–460.CrossRefPubMed
9.
Smith, A. W., Reeve, B. B., Bellizzi, K. M., Harlan, L. C., Klabunde, C. N., Amsellem, M., et al. (2008). Cancer, comorbidities, and health-related quality of life of older adults. Health Care Financ Rev, 29(4), 41–56.PubMedPubMedCentral
10.
Hays, R. D., Cunningham, W. E., Sherbourne, C. D., Wilson, I. B., Wu, A. W., Cleary, P. D., et al. (2000). Health-related quality of life in patients with human immunodeficiency virus infection in the United States: Results from the HIV Cost and Services Utilization Study. American Journal of Medicine, 108(9), 714–722.CrossRefPubMed
11.
Richardson, L. C., Wingo, P. A., Zack, M. M., Zahran, H. S., & King, J. B. (2008). Health-related quality of life in cancer survivors between ages 20 and 64 years: Population-based estimates from the Behavioral Risk Factor Surveillance System. Cancer, 112(6), 1380–1389.CrossRefPubMed
12.
Vogeli, C., Shields, A. E., Lee, T. A., Gibson, T. B., Marder, W. D., Weiss, K. B., et al. (2007). Multiple chronic conditions: Prevalence, health consequences, and implications for quality, care management, and costs. Journal of General Internal Medicine, 22(Suppl 3), 391–395.CrossRefPubMedPubMedCentral
13.
Lash, T. L., Mor, V., Wieland, D., Ferrucci, L., Satariano, W., & Silliman, R. A. (2007). Methodology, design, and analytic techniques to address measurement of comorbid disease. The journals of gerontology. Series A, Biological sciences and medical sciences, 62(3), 281–285.CrossRefPubMedPubMedCentral
14.
Iezzoni, L. I. (1997). Dimensions of risk. In L. I. Iezzoni (Ed.), Risk adjustment for measuring healthcare outcomes. Chicago, IL: Health Administration Press.
15.
Kaplan, M. H., & Feinstein, A. R. (1974). The importance of classifying initial co-morbidity in evaluation the outcome of diabetes mellitus. Journal of chronic diseases, 27(7–8), 387–404.CrossRefPubMed
16.
Fishman, P. A., Goodman, M. J., Hornbrook, M. C., Meenan, R. T., Bachman, D. J., & O’Keeffe Rosetti, M. C. (2003). Risk adjustment using automated ambulatory pharmacy data: The RxRisk model. Medical Care, 41(1), 84–99.CrossRefPubMed
17.
Clark, D. O., Von Korff, M., Saunders, K., Baluch, W. M., & Simon, G. E. (1995). A chronic disease score with empirically derived weights. Medical Care, 33(8), 783–795.CrossRefPubMed
18.
Elixhauser, A., Steiner, C., Harris, D. R., & Coffey, R. M. (1998). Comorbidity measures for use with administrative data. Medical Care, 36(1), 8–27.CrossRefPubMed
19.
Charlson, M. E., Pompei, P., Ales, K. L., & MacKenzie, C. R. (1987). A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. Journal of chronic diseases, 40(5), 373–383.CrossRefPubMed
20.
Linn, B. S., Linn, M. W., & Gurel, L. (1968). Cumulative illness rating scale. Journal of the American Geriatrics Society, 16(5), 622–626.CrossRefPubMed
21.
Mukherjee, B., Ou, H.-T., Wang, F., & Erickson, S. R. (2011). A new comorbidity index: The health-related quality of life comorbidity index. Journal of Clinical Epidemiology, 64(3), 309–319.CrossRefPubMed
22.
Groll, D. L., To, T., Bombardier, C., & Wright, J. G. (2005). The development of a comorbidity index with physical function as the outcome. Journal of Clinical Epidemiology, 58(6), 595–602.CrossRefPubMed
23.
Extermann, M., Overcash, J., Lyman, G. H., Parr, J., & Balducci, L. (1998). Comorbidity and functional status are independent in older cancer patients. Journal of Clinical Oncology, 16(4), 1582–1587.PubMed
24.
Repetto, L., Fratino, L., Audisio, R. A., Venturino, A., Gianni, W., Vercelli, M., et al. (2002). Comprehensive geriatric assessment adds information to Eastern Cooperative Oncology Group performance status in elderly cancer patients: An Italian Group for Geriatric Oncology Study. Journal of Clinical Oncology, 20(2), 494–502.CrossRefPubMed
25.
Rothrock, N. E., Hays, R. D., Spritzer, K., Yount, S. E., Riley, W., & Cella, D. (2010). Relative to the general US population, chronic diseases are associated with poorer health-related quality of life as measured by the Patient-Reported Outcomes Measurement Information System (PROMIS). Journal of Clinical Epidemiology, 63(11), 1195–1204.CrossRefPubMedPubMedCentral
26.
Ou, H.-T., Mukherjee, B., Erickson, S. R., Piette, J. D., Bagozzi, R. P., & Balkrishnan, R. (2011). Comparative performance of comorbidity indices in discriminating health-related behaviors and outcomes. Health Outcomes Research in Medicine, 2(2), e91–e104.CrossRef
27.
Ou, H.-T., Mukherjee, B., Erickson, S. R., Piette, J. D., Bagozzi, R. P., & Balkrishnan, R. (2012). Comparative performance of comorbidity indices in predicting health care-related behaviors and outcomes among medicaid enrollees with type 2 diabetes. Population Health Management, 15(4), 220–229.CrossRefPubMedPubMedCentral
28.
Deyo, R. A., Cherkin, D. C., & Ciol, M. A. (1992). Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. Journal of Clinical Epidemiology, 45(6), 613–619.CrossRefPubMed
29.
Charlson, M., Szatrowski, T. P., Peterson, J., & Gold, J. (1994). Validation of a combined comorbidity index. Journal of Clinical Epidemiology, 47(11), 1245–1251.CrossRefPubMed
30.
D’Hoore, W., Bouckaert, A., & Tilquin, C. (1996). Practical considerations on the use of the Charlson comorbidity index with administrative data bases. Journal of Clinical Epidemiology, 49(12), 1429–1433.CrossRefPubMed
31.
D’Hoore, W., Sicotte, C., & Tilquin, C. (1993). Risk adjustment in outcome assessment: The Charlson comorbidity index. Methods of Information in Medicine, 32(5), 382–387.PubMed
32.
Brazier, J. E., & Roberts, J. (2004). The estimation of a preference-based measure of health from the SF-12. Medical Care, 42(9), 851–859.CrossRefPubMed
33.
EuroQol, G. (1990). EuroQol–a new facility for the measurement of health-related quality of life. Health Policy, 16(3), 199–208.CrossRef
34.
Shaw, J. W., Johnson, J. A., & Coons, S. J. (2005). US valuation of the EQ-5D health states: Development and testing of the D1 valuation model. Medical Care, 43(3), 203–220.CrossRefPubMed
35.
Tibshirani, R. (1996). Regression shrinkage and selection via the lasso. Journal of the Royal Statistical Society. Series B (Methodological), 58(1), 267–288.
36.
Christoffersson, A. (1975). Factor analysis of dichotomized variables. Psychometrika, 40(1), 5–32.CrossRef
37.
Schumacker, R. E., & Lomax, R. G. (2004). A beginner’s guide to structural equation modeling (2nd ed.). Mahwah, NJ: Lawrence Erlbaum Associates.
38.
Marsh, H. W., Hau, K. T., & Wen, Z. (2004). In search of golden rules: Comment on hypothesis-testing approaches to setting cutoff values for fit indices and dangers in overgeneralizing Hu and Bentler’s (1999). Structural Equation Modeling, 11, 320–341.CrossRef
39.
Hu, L., & Bentler, P. M. (1998). Fit indices in covariance structure analysis: Sensitivity to under-parameterized model misspecification. Psychological Methods, 3, 424–453.CrossRef
40.
Baumgartner, H., & Homburg, C. (1996). Applications of structural equation modeling in marketing and consumer research: A review. International Journal of Research in Marketing, 13(2), 139–161.CrossRef
41.
Breusch, T. S., & Pagan, A. R. (1979). A simple test for heteroscedasticity and random coefficient variation. Econometrica: Journal of the Econometric Society, 47(5), 1287–1294.CrossRef
42.
Petrou, S., & Hockley, C. (2005). An investigation into the empirical validity of the EQ-5D and SF-6D based on hypothetical preferences in a general population. Health Economics, 14(11), 1169–1189.CrossRefPubMed
Metadaten
Titel
Refined comorbidity index based on dimensionality of comorbidity for use in studies of health-related quality of life
verfasst von
Huang-Tz Ou
Chung-Ying Lin
Steven R. Erickson
Rajesh Balkrishnan
Publikationsdatum
30.04.2016
Verlag
Springer International Publishing
Erschienen in
Quality of Life Research / Ausgabe 10/2016
Print ISSN: 0962-9343
Elektronische ISSN: 1573-2649
DOI
https://doi.org/10.1007/s11136-016-1306-6

Weitere Artikel der Ausgabe 10/2016

Quality of Life Research 10/2016 Zur Ausgabe

OriginalPaper

Skin toxicity and quality of life during treatment with panitumumab for RAS wild-type metastatic colorectal carcinoma: results from three randomised clinical trials

OriginalPaper

Health state descriptions, valuations and individuals’ capacity to walk: a comparative evaluation of preference-based instruments in the context of spinal cord injury

OriginalPaper

HDQLIFE: the development of two new computer adaptive tests for use in Huntington disease, Speech Difficulties, and Swallowing Difficulties

Brief Communication

Change in health-related quality of life over 1 month in cancer patients with high initial levels of symptoms and problems

Brief Communication

Association of physical fitness with health-related quality of life in early postmenopause

Brief Communication

The Swedish SCOPA-SLEEP for assessment of sleep disorders in Parkinson’s disease and healthy controls