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Hwang J, Jang JH. Assessing Trends in Hospitalizations for Breast Cancer among Women in Korea: A Utilization of the Korea National Hospital Discharge In-depth Injury Survey (2006-2020). J Epidemiol Glob Health 2024:10.1007/s44197-024-00229-1. [PMID: 38683484 DOI: 10.1007/s44197-024-00229-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 04/11/2024] [Indexed: 05/01/2024] Open
Abstract
OBJECTIVE Breast cancer poses a significant health threat globally and particularly in Korea, where mortality rates have risen notably. In this study, we analyzed the characteristics of breast cancer patients discharged in Korea over the past 15 years and explored the association between comorbidities and treatment outcomes to propose effective strategies for managing cancer patients. Understanding these dynamics is vital for informing tailored management strategies and optimizing healthcare system sustainability. METHODS This study utilized cross-sectional data from the Korea National Hospital Discharge In-depth Injury Survey from 2006 to 2020. Each year, among patients discharged from hospital with 100 beds or more, those identified with breast cancer patients were based on their primary diagnosis code (C50) according to the ICD-10, as recorded in their medical records. RESULTS Between 2006 and 2020, an estimated 499,281 breast cancer patients were discharged, with an average annual percent change (AAPC) of 5.2% (95% CI 4.2-6.2, p <.05). A notable increase in AAPC was particularly evident among those aged 60 years and old. Across all age groups, there was a consistent increasing trend in the risk of mortality as the CCI score increased (p <.05). The risk of comorbidity was more pronounced in younger age groups compared to older age groups. CONCLUSIONS The increasing life expectancy is expected to lead to a continued rise in the number of elderly breast cancer patients. Countermeasures are needed to address this trend through appropriate diagnosis and treatment planning. Particularly, considering comorbidities in breast cancer treatment plans is necessary to promote positive treatment outcomes, especially in younger breast cancer patients.
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Affiliation(s)
- Jieun Hwang
- Department of Health Administration, College of Health Science, Dankook University, 31116, Cheonan City, Chungcheongnam-do, South Korea
| | - Jeong-Hoon Jang
- College of Pharmacy, Daegu Catholic University, 38430, Gyeongsan-si, Gyeongsangbuk-do, South Korea.
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2
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Monhart Z. Clinical assessment and management of patients with multimorbidity. VNITRNI LEKARSTVI 2023; 69:173-180. [PMID: 37468312 DOI: 10.36290/vnl.2023.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
Internal medicine specialists, also known as general internal medicine specialists are specialist physicians trained to manage particularly complex or multisystem disease conditions that single-organ-disease specialists may not be trained to deal with. The management of multimorbidity, however, is often complex, and requires specific clinical skills and corresponding experience in appropriate diagnostic and therapeutic procedures. Multimorbidity is associated with a decline in many aspects of health and in consequence with an increase in hospital admissions, polypharmacy, and use of health care and social resouces. When prescribing medicine to patients with multimorbidity, all the risks and benefits, as well as possible interactions should be carefully considered. The prescription appropriateness can be assessed by validated tools like STOPP-START criteria. Beneficial part of good prescribing is deprescribing - planned and supervised process of dose reduction or withdrawal of medications that are no longer needed in the circumstances of the patient.
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The Impact of Frailty Screening on Radiation Treatment Modification. Cancers (Basel) 2022; 14:cancers14041072. [PMID: 35205820 PMCID: PMC8870720 DOI: 10.3390/cancers14041072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 02/12/2022] [Accepted: 02/15/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Care overburden makes it difficult to perform comprehensive geriatric assessments (CGAs) in oncology settings. We analyzed if screening tools modified radiotherapy in oncogeriatric patients. METHODS Patients ≥ 65 years, irradiated between December 2020 and March 2021 at the Hospital Provincial de Castellón, completed the frailty G8 and estimated survival Charlson questionnaires. The cohort was stratified between G8 score ≤ 14 (fragile) or >14 (robust); the cutoff point for the Charlson index was established at five. RESULTS Of 161 patients; 69.4% were male, the median age was 75 years (range 65-91), and the prevailing performance status (PS) was 0-1 (83.1%). Overall, 28.7% of the cohort were frail based on G8 scores, while the estimated survival at 10 years was 2.25% based on the Charlson test. The treatment administered changed up to 21% after frailty analysis. The therapies prescribed were 5.8 times more likely to be modified in frail patients based on the G8 test. In addition, patients ≥ 85 years (p = 0.01), a PS ≥ 2 (p = 0.008), and limited mobility (p = 0.024) were also associated with a potential change. CONCLUSIONS CGAs remain the optimal assessment tool in oncogeriatry. However, we found that the G8 fragility screening test, which is easier to integrate into patient consultations, is a reliable and efficient aid to rapid decision making.
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Charlson ME, Carrozzino D, Guidi J, Patierno C. Charlson Comorbidity Index: A Critical Review of Clinimetric Properties. PSYCHOTHERAPY AND PSYCHOSOMATICS 2022; 91:8-35. [PMID: 34991091 DOI: 10.1159/000521288] [Citation(s) in RCA: 318] [Impact Index Per Article: 159.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 11/19/2022]
Abstract
The present critical review was conducted to evaluate the clinimetric properties of the Charlson Comorbidity Index (CCI), an assessment tool designed specifically to predict long-term mortality, with regard to its reliability, concurrent validity, sensitivity, incremental and predictive validity. The original version of the CCI has been adapted for use with different sources of data, ICD-9 and ICD-10 codes. The inter-rater reliability of the CCI was found to be excellent, with extremely high agreement between self-report and medical charts. The CCI has also been shown either to have concurrent validity with a number of other prognostic scales or to result in concordant predictions. Importantly, the clinimetric sensitivity of the CCI has been demonstrated in a variety of medical conditions, with stepwise increases in the CCI associated with stepwise increases in mortality. The CCI is also characterized by the clinimetric property of incremental validity, whereby adding the CCI to other measures increases the overall predictive accuracy. It has been shown to predict long-term mortality in different clinical populations, including medical, surgical, intensive care unit (ICU), trauma, and cancer patients. It may also predict in-hospital mortality, although in some instances, such as ICU or trauma patients, the CCI did not perform as well as other instruments designed specifically for that purpose. The CCI thus appears to be clinically useful not only to provide a valid assessment of the patient's unique clinical situation, but also to demarcate major diagnostic and prognostic differences among subgroups of patients sharing the same medical diagnosis.
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Affiliation(s)
- Mary E Charlson
- Division of Clinical Epidemiology and Evaluative Sciences Research, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Danilo Carrozzino
- Department of Psychology "Renzo Canestrari," University of Bologna, Bologna, Italy
| | - Jenny Guidi
- Department of Psychology "Renzo Canestrari," University of Bologna, Bologna, Italy
| | - Chiara Patierno
- Department of Psychology "Renzo Canestrari," University of Bologna, Bologna, Italy
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5
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Huang YJ, Chen JS, Luo SF, Kuo CF. Comparison of Indexes to Measure Comorbidity Burden and Predict All-Cause Mortality in Rheumatoid Arthritis. J Clin Med 2021; 10:jcm10225460. [PMID: 34830741 PMCID: PMC8618526 DOI: 10.3390/jcm10225460] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/04/2021] [Accepted: 11/11/2021] [Indexed: 11/20/2022] Open
Abstract
Objectives: To examine the comorbidity burden in patients with rheumatoid arthritis (RA) patients using a nationwide population-based cohort by assessing the Charlson Comorbidity Index (CCI), Elixhauser Comorbidity Index (ECI), Multimorbidity Index (MMI), and Rheumatic Disease Comorbidity Index (RDCI) scores and to investigate their predictive ability for all-cause mortality. Methods: We identified 24,767 RA patients diagnosed from 1998 to 2008 in Taiwan and followed up until 31 December 2013. The incidence of comorbidities was estimated in three periods (before, during, and after the diagnostic period). The incidence rate ratios were calculated by comparing during vs. before and after vs. before the diagnostic period. One- and 5-year mortality rates were calculated and discriminated by low and high-score groups and modified models for each index. Results: The mean score at diagnosis was 0.8 in CCI, 2.8 in ECI, 0.7 in MMI, and 1.3 in RDCI, and annual percentage changes are 11.0%, 11.3%, 9.7%, and 6.8%, respectively. The incidence of any increase in the comorbidity index was significantly higher in the periods of “during” and “after” the RA diagnosis (incidence rate ratios for different indexes: 1.33–2.77). The mortality rate significantly differed between the high and low-score groups measured by each index (adjusted hazard ratios: 2.5–4.3 for different indexes). CCI was slightly better in the prediction of 1- and 5-year mortality rates. Conclusions: Comorbidities are common before and after RA diagnosis, and the rate of accumulation accelerates after RA diagnosis. All four comorbidity indexes are useful to measure the temporal changes and to predict mortality.
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Beyrer J, Manjelievskaia J, Bonafede M, Lenhart G, Nolot S, Haldane D, Johnston J. Validation of an International Classification of Disease, 10th revision coding adaptation for the Charlson Comorbidity Index in United States healthcare claims data. Pharmacoepidemiol Drug Saf 2021; 30:582-593. [PMID: 33580525 PMCID: PMC8252530 DOI: 10.1002/pds.5204] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 02/08/2021] [Indexed: 01/12/2023]
Abstract
PURPOSE An International Classification of Disease (ICD-10) Charlson Comorbidity Index (CCI) adaptation had not been previously developed and validated for United States (US) healthcare claims data. Many researchers use the Canadian adaption by Quan et al (2005), not validated in US data. We sought to evaluate the predictive validity of a US ICD-10 CCI adaptation in US claims and compare it with the Canadian standard. METHODS Diverse patient cohorts (rheumatoid arthritis, hip/knee replacement, lumbar spine surgery, acute myocardial infarction [AMI], stroke, pneumonia) in the IBM® MarketScan® Research Databases were linked with the IBM MarketScan Mortality file. Predictive performance was measured using c-statistics for binary outcomes (1-year and postoperative mortality, in-hospital complications) and root mean square prediction error (RMSE) for continuous outcomes (1-year all-cause medical costs, index hospitalization costs, length of stay [LOS]), after adjusting for age and sex. C-statistics were compared by the method of DeLong and colleagues (1988); RMSEs, by resampling. RESULTS C-statistics were generally high (≥ ~ 0.8) for mortality but lower for in-hospital complications (~0.6-0.7). RMSEs for costs and hospitalization LOS were relatively large and comparable to standard deviations. Results were similar overall between the US and Canadian adaptations, with relative differences typically <1%. CONCLUSIONS This US-based coding adaptation and a previously published Canadian adaptation resulted in similar predictive ability for all outcomes evaluated but may have different construct validity (not evaluated in our study). We recommend using adaptations specific to the country of data origin based on good research practice.
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Affiliation(s)
- Julie Beyrer
- Global Patient Outcomes and Real World EvidenceEli Lilly and CompanyIndianapolisIndianaUSA
| | | | | | - Gregory Lenhart
- IBM's Life SciencesIBM Watson HealthCambridgeMassachusettsUSA
| | - Sandra Nolot
- Global Patient Outcomes and Real World EvidenceEli Lilly and CompanyIndianapolisIndianaUSA
| | - Diane Haldane
- Global Patient Outcomes and Real World EvidenceEli Lilly and CompanyIndianapolisIndianaUSA
| | - Joseph Johnston
- Global Patient Outcomes and Real World EvidenceEli Lilly and CompanyIndianapolisIndianaUSA
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de Boer AZ, Bastiaannet E, Putter H, Marang-van de Mheen PJ, Siesling S, de Munck L, de Ligt KM, Portielje JEA, Liefers GJ, de Glas NA. Prediction of Other-Cause Mortality in Older Patients with Breast Cancer Using Comorbidity. Cancers (Basel) 2021; 13:cancers13071627. [PMID: 33915755 PMCID: PMC8036543 DOI: 10.3390/cancers13071627] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/19/2021] [Accepted: 03/25/2021] [Indexed: 12/16/2022] Open
Abstract
Simple Summary Selecting older patients for adjuvant breast cancer treatments is challenging as its benefits can be diminished by shorter life expectancies. In addition to age, comorbidity increases the risk of dying from other causes than breast cancer. Available prediction tools have either not adjusted for individual comorbidities or have shown inaccurate predictions when a higher number of comorbidities are present. Up to now, an optimal comorbidity score to be used in prediction tools has not been established. Therefore, this study aimed to assess the predictive value of the Charlson comorbidity index for other-cause mortality and to compare these predictions with using a simple comorbidity count. We found that the Charlson index performed similarly as comorbidity count. The use of comorbidity count in the development of new prediction tools for older patients with breast cancer is recommended as its simplicity enhances the tool’s applicability in clinical practice. Abstract Background: Individualized treatment in older patients with breast cancer can be improved by including comorbidity and other-cause mortality in prediction tools, as the other-cause mortality risk strongly increases with age. However, no optimal comorbidity score is established for this purpose. Therefore, this study aimed to compare the predictive value of the Charlson comorbidity index for other-cause mortality with the use of a simple comorbidity count and to assess the impact of frequently occurring comorbidities. Methods: Surgically treated patients with stages I-III breast cancer aged ≥70 years diagnosed between 2003 and 2009 were selected from the Netherlands Cancer Registry. Competing risk analysis was performed to associate 5-year other-cause mortality with the Charlson index, comorbidity count, and specific comorbidities. Discrimination and calibration were assessed. Results: Overall, 7511 patients were included. Twenty-nine percent had no comorbidities, and 59% had a Charlson score of 0. After five years, in 1974, patients had died (26%), of which 1450 patients without a distant recurrence (19%). Besides comorbidities included in the Charlson index, the psychiatric disease was strongly associated with other-cause mortality (sHR 2.44 (95%-CI 1.70–3.50)). The c-statistics of the Charlson index and comorbidity count were similar (0.65 (95%-CI 0.64–0.65) and 0.64 (95%-CI 0.64–0.65)). Conclusions: The predictive value of the Charlson index for 5-year other-cause mortality was similar to using comorbidity count. As it is easier to use in clinical practice, our findings indicate that comorbidity count can aid in improving individualizing treatment in older patients with breast cancer. Future studies should elicit whether geriatric parameters could improve prediction.
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Affiliation(s)
- Anna Z. de Boer
- Department of Surgery, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (A.Z.d.B.); (E.B.); (G.J.L.)
- Department of Medical Oncology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands;
| | - Esther Bastiaannet
- Department of Surgery, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (A.Z.d.B.); (E.B.); (G.J.L.)
- Department of Medical Oncology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands;
| | - Hein Putter
- Department of Medical Statistics, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands;
| | | | - Sabine Siesling
- Department of Research and Development, Netherlands Comprehensive Cancer Organization, 3500 BN Utrecht, The Netherlands; (S.S.); (L.d.M.); (K.M.d.L.)
- Department of Health Technology and Services Research, Technical Medical Center, University of Twente, 7522 NB Enschede, The Netherlands
| | - Linda de Munck
- Department of Research and Development, Netherlands Comprehensive Cancer Organization, 3500 BN Utrecht, The Netherlands; (S.S.); (L.d.M.); (K.M.d.L.)
| | - Kelly M. de Ligt
- Department of Research and Development, Netherlands Comprehensive Cancer Organization, 3500 BN Utrecht, The Netherlands; (S.S.); (L.d.M.); (K.M.d.L.)
- Department of Health Technology and Services Research, Technical Medical Center, University of Twente, 7522 NB Enschede, The Netherlands
| | | | - Gerrit Jan Liefers
- Department of Surgery, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (A.Z.d.B.); (E.B.); (G.J.L.)
| | - Nienke A. de Glas
- Department of Medical Oncology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands;
- Correspondence:
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8
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Soh CH, Hassan SWU, Sacre J, Lim WK, Maier AB. Do morbidity measures predict the decline of activities of daily living and instrumental activities of daily living amongst older inpatients? A systematic review. Int J Clin Pract 2021; 75:e13838. [PMID: 33202078 PMCID: PMC8047900 DOI: 10.1111/ijcp.13838] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 11/05/2020] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES Older adults often suffer from multimorbidity, which results in hospitalisations. These are often associated with poor health outcomes such as functional dependence and mortality. The aim of this review was to summarise the current literature on the capacities of morbidity measures in predicting activities of daily living (ADL) and instrumental activities of daily living (IADL) amongst inpatients. METHODS A systematic literature search was performed using four databases: Medline, Cochrane, Embase, and Cinahl Central from inception to 6th March 2019. Keywords included comorbidity, multimorbidity, ADL, and iADL, along with specific morbidity measures. Articles reporting on morbidity measures predicting ADL and IADL decline amongst inpatients aged 65 years or above were included. RESULTS Out of 7334 unique articles, 12 articles were included reporting on 7826 inpatients (mean age 77.6 years, 52.7% females). Out of five morbidity measures, the Charlson Comorbidity Index was most often reported. Overall, morbidity measures were poorly associated with ADL and IADL decline amongst older inpatients. CONCLUSION Morbidity measures are poor predictors for ADL or IADL decline amongst older inpatients and follow-up duration does not alter the performance of morbidity measures.
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Affiliation(s)
- Cheng Hwee Soh
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia
| | - Syed Wajih Ul Hassan
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia
| | - Julian Sacre
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia
| | - Wen Kwang Lim
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia
| | - Andrea B Maier
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia
- Department of Human Movement Sciences, @AgeAmsterdam, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
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9
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Hua-Gen Li M, Hutchinson A, Tacey M, Duke G. Reliability of comorbidity scores derived from administrative data in the tertiary hospital intensive care setting: a cross-sectional study. BMJ Health Care Inform 2019; 26:bmjhci-2019-000016. [PMID: 31039124 PMCID: PMC7062318 DOI: 10.1136/bmjhci-2019-000016] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2019] [Indexed: 12/22/2022] Open
Abstract
Background Hospital reporting systems commonly use administrative data to calculate comorbidity scores in order to provide risk-adjustment to outcome indicators. Objective We aimed to elucidate the level of agreement between administrative coding data and medical chart review for extraction of comorbidities included in the Charlson Comorbidity Index (CCI) and Elixhauser Index (EI) for patients admitted to the intensive care unit of a university-affiliated hospital. Method We conducted an examination of a random cross-section of 100 patient episodes over 12 months (July 2012 to June 2013) for the 19 CCI and 30 EI comorbidities reported in administrative data and the manual medical record system. CCI and EI comorbidities were collected in order to ascertain the difference in mean indices, detect any systematic bias, and ascertain inter-rater agreement. Results We found reasonable inter-rater agreement (kappa (κ) coefficient ≥0.4) for cardiorespiratory and oncological comorbidities, but little agreement (κ<0.4) for other comorbidities. Comorbidity indices derived from administrative data were significantly lower than from chart review: −0.81 (95% CI − 1.29 to − 0.33; p=0.001) for CCI, and −2.57 (95% CI −4.46 to −0.68; p=0.008) for EI. Conclusion While cardiorespiratory and oncological comorbidities were reliably coded in administrative data, most other comorbidities were under-reported and an unreliable source for estimation of CCI or EI in intensive care patients. Further examination of a large multicentre population is required to confirm our findings.
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Affiliation(s)
- Michael Hua-Gen Li
- Northern Clinical Research Centre, The Northern Hospital, Epping, Victoria, Australia
| | - Anastasia Hutchinson
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Mark Tacey
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Department of Intensive Care, Box Hill Hospital, Box Hill, Victoria, Australia
| | - Graeme Duke
- Department of Intensive Care, The Northern Hospital, Epping, Victoria, Australia
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Reinold J, Palese F, Romanese F, Logroscino G, Riedel O, Pisa FE. Anticholinergic burden before and after hospitalization in older adults with dementia: Increase due to antipsychotic medications. Int J Geriatr Psychiatry 2019; 34:868-880. [PMID: 30761624 DOI: 10.1002/gps.5084] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 02/03/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To evaluate changes in the use of antipsychotics and medications with anticholinergic activity (MACs) during hospitalization in older adults with dementia and factors associated with antipsychotic prescriptions and increased anticholinergic burden (ACB). METHODS AND DESIGN This retrospective cohort study included all patients aged 65 years or older with a discharge diagnosis of dementia hospitalized at the university hospital of Udine, Italy, from 2012 to 2014. Medications dispensed within 3 months before and after hospitalization were identified in community-pharmacy dispensations while those prescribed at discharge were collected from Hospital Electronic Medical Records (EMR). ACB was assessed using the Anticholinergic Cognitive Burden score. RESULTS Among 1908 patients included, at discharge, 37.0% used one or more antipsychotic (9.4% before and 12.6% after hospitalization), 68.6% used one or more MAC (49.1% and 45.7%, respectively), and ACB of 38.4% of patients increased at discharge mainly because of a higher use of antipsychotics with anticholinergic activity (33% at discharge vs 12% before hospitalization). Prescription of antipsychotics at discharge was associated with prior treatment with antipsychotics (adjusted odds ratio [aOR] 4.85; 95%CI, 3.37-6.97), psychiatric conditions, (4.39; 3.47-5.54) and discharge from surgical department (2.17; 1.32-3.55). An increased ACB was associated with psychiatric conditions (1.91; 1.52-2.39), discharge from surgical (1.75; 1.09-2.80) or medical department (1.50; 1.04-2.17), and with cardiac insufficiency (1.41; 1.00-1.99). CONCLUSIONS ACB was higher at discharge, and antipsychotics were the main drivers of this increase. Clinicians treating older adults with dementia should be aware of the risks associated with antipsychotics and that some of these medications may increase the risk of anticholinergic effects.
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Affiliation(s)
- Jonas Reinold
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology BIPS, Bremen, Germany
| | | | | | - Giancarlo Logroscino
- Neurodegenerative Diseases Unit, Department of Basic Medicine Neuroscience and Sense Organs, Department of Clinical Research in Neurology of the University of Bari at "Pia Fondazione Card. G.Panico" Hospital Tricase, University of Bari, Lecce, Italy
| | - Oliver Riedel
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology BIPS, Bremen, Germany
| | - Federica E Pisa
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology BIPS, Bremen, Germany
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11
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Souza J, Santos JV, Canedo VB, Betanzos A, Alves D, Freitas A. Importance of coding co-morbidities for APR-DRG assignment: Focus on cardiovascular and respiratory diseases. Health Inf Manag 2019; 49:47-57. [PMID: 31043088 DOI: 10.1177/1833358319840575] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND The All Patient-Refined Diagnosis-Related Groups (APR-DRGs) system has adjusted the basic DRG structure by incorporating four severity of illness (SOI) levels, which are used for determining hospital payment. A comprehensive report of all relevant diagnoses, namely the patient's underlying co-morbidities, is a key factor for ensuring that SOI determination will be adequate. OBJECTIVE In this study, we aimed to characterise the individual impact of co-morbidities on APR-DRG classification and hospital funding in the context of respiratory and cardiovascular diseases. METHODS Using 6 years of coded clinical data from a nationwide Portuguese inpatient database and support vector machine (SVM) models, we simulated and explored the APR-DRG classification to understand its response to individual removal of Charlson and Elixhauser co-morbidities. We also estimated the amount of hospital payments that could have been lost when co-morbidities are under-reported. RESULTS In our scenario, most Charlson and Elixhauser co-morbidities did considerably influence SOI determination but had little impact on base APR-DRG assignment. The degree of influence of each co-morbidity on SOI was, however, quite specific to the base APR-DRG. Under-coding of all studied co-morbidities led to losses in hospital payments. Furthermore, our results based on the SVM models were consistent with overall APR-DRG grouping logics. CONCLUSION AND IMPLICATIONS Comprehensive reporting of pre-existing or newly acquired co-morbidities should be encouraged in hospitals as they have an important influence on SOI assignment and thus on hospital funding. Furthermore, we recommend that future guidelines to be used by medical coders should include specific rules concerning coding of co-morbidities.
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Affiliation(s)
- Julio Souza
- Faculty of Medicine of the University of Porto, Portugal.,CINTESIS - Center for Health Technology and Services Research, Portugal
| | - João Vasco Santos
- Faculty of Medicine of the University of Porto, Portugal.,CINTESIS - Center for Health Technology and Services Research, Portugal.,Public Health Unit, ACES Grande Porto VIII - Espinho/Gaia, Portugal
| | | | | | - Domingos Alves
- CINTESIS - Center for Health Technology and Services Research, Portugal.,Ribeirão Preto Medical School of the University of São Paulo, Brazil
| | - Alberto Freitas
- Faculty of Medicine of the University of Porto, Portugal.,CINTESIS - Center for Health Technology and Services Research, Portugal
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12
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Torres-Espíndola LM, Demetrio-Ríos J, Carmona-Aparicio L, Galván-Díaz C, Pérez-García M, Chávez-Pacheco JL, Granados-Montiel J, Torres-Ramírez de Arellano I, Aquino-Gálvez A, Castillejos-López MDJ. Comorbidity Index as a Predictor of Mortality in Pediatric Patients With Solid Tumors. Front Pediatr 2019; 7:48. [PMID: 30881949 PMCID: PMC6405632 DOI: 10.3389/fped.2019.00048] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 02/05/2019] [Indexed: 11/13/2022] Open
Abstract
Purpose: The objective of this study was to determine whether a comorbidity index could be used to predict mortality in pediatric patients with chemotherapy-treated solid tumors. Methods: Pediatric patients who underwent chemotherapy treatment for solid tumors were included, and demographic, clinical, and comorbidity data were obtained from patient electronic records. Results: A total of 196 pediatric patients with embryonic solid tumors were included. Metastatic tumors were the most frequently observed (n = 103, 52.6%). The most common comorbidities encountered for the Charlson comorbidity index (CCI) were cellulitis (n = 24, 12.2%) and acute renal failure (n = 15, 7.7%). For the Pediatric Comorbidity Index (PCI), the most frequent comorbidities were pneumonia and sepsis, with n = 64 (32.7%) for each. We evaluated established the prognostic values for both indexes using Kaplan-Meier curves, finding that the CCI and PCI could predict mortality with p < 0.0001. Conclusion: Using the PCI, we observed 100% survival in patients without comorbidities, 70% survival in patients with a low degree of comorbidity, and 20% survival in patients with a high degree of comorbidity. Greater discrimination of probability of survival could be achieved using degrees of comorbidity on the PCI than using degrees of comorbidity on the CCI. The application of the PCI for assessing the hospitalized pediatric population may be of importance for improving clinical evaluation.
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Affiliation(s)
| | - Joel Demetrio-Ríos
- Pharmacology Laboratory, National Institute of Pediatrics, Mexico City, Mexico
| | | | - César Galván-Díaz
- Oncology Service, National Institute of Pediatrics, Mexico City, Mexico
| | | | | | - Julio Granados-Montiel
- Tissue Engineering, Cell Therapy and Regenerative Medicine Unit, National Institute of Rehabilitation, Mexico City, Mexico
| | | | - Arnoldo Aquino-Gálvez
- Biomedical Oncology Laboratory, National Institute of Respiratory Diseases, Mexico City, Mexico
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Kim YH, Cho KH, Kim KH, Ryu EJ, Han KD, Kim JS. Predicting hypertension among Korean cancer survivors: A nationwide population-based study. Eur J Cancer Care (Engl) 2018; 27:e12803. [PMID: 29333686 DOI: 10.1111/ecc.12803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2017] [Indexed: 12/16/2022]
Abstract
Hypertension is the most common comorbidity among cancer survivors, although there is no model for predicting hypertension in this population. Therefore, we developed a model for predicting hypertension using data from 6,480 Korean cancer survivors who were ≥20 years old. The odds ratios (ORs) for hypertension were calculated using stepwise logistic regression analyses, and a nomogram was generated to predict hypertension. Hypertension was independently associated with an age of ≥65 years (OR: 3.058), male gender (OR: 1.195), obesity (OR: 1.998), prehypertension (OR: 2.06), dyslipidaemia (OR: 2.011) and diabetes mellitus (OR: 2.297). Each variable in the nomogram was assigned a specific number of points, and the total score (range: 0-400) was used to obtain a value for predicting hypertension. The estimated prevalence of hypertension increased when the total nomogram score exceeded the sixth decile (total points: 128; p for trend <.001). Therefore, among Korean cancer survivors, hypertension was significantly associated with an age of >65 years, male gender, obesity, and having various comorbidities (e.g., prehypertension, dyslipidaemia and diabetes mellitus). Furthermore, our nomogram could predict the incidence of hypertension, and the sixth decile of the total nomogram score predicted an increased risk of hypertension.
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Affiliation(s)
- Y-H Kim
- Department of Family Medicine, Korea University College of Medicine, Seoul, Korea
| | - K-H Cho
- Department of Family Medicine, Korea University College of Medicine, Seoul, Korea
| | - K H Kim
- Department of Nursing, Chung-Ang University, Seoul, Korea
| | - E J Ryu
- Department of Nursing, Chung-Ang University, Seoul, Korea
| | - K D Han
- Department of Medical Statistics, Catholic University College of Medicine, Seoul, Korea
| | - J-S Kim
- Department of Nursing, Chung-Ang University, Seoul, Korea
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García Caballero R, Herreros B, Real de Asúa D, Gámez S, Vega G, García Olmos L. Limitación del esfuerzo terapéutico en pacientes hospitalizados en servicios de medicina interna. Rev Clin Esp 2018; 218:1-6. [DOI: 10.1016/j.rce.2017.10.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 08/04/2017] [Accepted: 10/03/2017] [Indexed: 10/18/2022]
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García Caballero R, Herreros B, Real de Asúa D, Gámez S, Vega G, García Olmos L. Limitation of therapeutic effort in patients hospitalized in departments of internal medicine. Rev Clin Esp 2018. [DOI: 10.1016/j.rceng.2017.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Lichtensztajn DY, Giddings BM, Morris CR, Parikh-Patel A, Kizer KW. Comorbidity index in central cancer registries: the value of hospital discharge data. Clin Epidemiol 2017; 9:601-609. [PMID: 29200890 PMCID: PMC5700816 DOI: 10.2147/clep.s146395] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The presence of comorbid medical conditions can significantly affect a cancer patient’s treatment options, quality of life, and survival. However, these important data are often lacking from population-based cancer registries. Leveraging routine linkage to hospital discharge data, a comorbidity score was calculated for patients in the California Cancer Registry (CCR) database. Methods California cancer cases diagnosed between 1991 and 2013 were linked to statewide hospital discharge data. A Deyo and Romano adapted Charlson Comorbidity Index was calculated for each case, and the association of comorbidity score with overall survival was assessed with Kaplan–Meier curves and Cox proportional hazards models. Using a subset of Medicare-enrolled CCR cases, the index was validated against a comorbidity score derived using Surveillance, Epidemiology, and End Results (SEER)-Medicare linked data. Results A comorbidity score was calculated for 71% of CCR cases. The majority (60.2%) had no relevant comorbidities. Increasing comorbidity score was associated with poorer overall survival. In a multivariable model, high comorbidity conferred twice the risk of death compared to no comorbidity (hazard ratio 2.33, 95% CI: 2.32–2.34). In the subset of patients with a SEER-Medicare-derived score, the sensitivity of the hospital discharge-based index for detecting any comorbidity was 76.5. The association between overall mortality and comorbidity score was stronger for the hospital discharge-based score than for the SEER-Medicare-derived index, and the predictive ability of the hospital discharge-based score, as measured by Harrell’s C index, was also slightly better for the hospital discharge-based score (C index 0.62 versus 0.59, P<0.001). Conclusions Despite some limitations, using hospital discharge data to construct a comorbidity index for cancer registries is a feasible and valid method to enhance registry data, which can provide important clinically relevant information for population-based cancer outcomes research.
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Affiliation(s)
| | - Brenda M Giddings
- California Cancer Reporting and Epidemiologic Surveillance Program, Institute for Population Health Improvement, UC Davis Health, CA, USA
| | - Cyllene R Morris
- California Cancer Reporting and Epidemiologic Surveillance Program, Institute for Population Health Improvement, UC Davis Health, CA, USA
| | - Arti Parikh-Patel
- California Cancer Reporting and Epidemiologic Surveillance Program, Institute for Population Health Improvement, UC Davis Health, CA, USA
| | - Kenneth W Kizer
- California Cancer Reporting and Epidemiologic Surveillance Program, Institute for Population Health Improvement, UC Davis Health, CA, USA
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A Preliminary Study on the Efficacy of a Community-Based Physical Activity Intervention on Physical Function-Related Risk Factors for Falls Among Breast Cancer Survivors. Am J Phys Med Rehabil 2017; 95:561-70. [PMID: 26829081 DOI: 10.1097/phm.0000000000000440] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The aim of this study was to examine the effects of a 6-week community-based physical activity (PA) intervention on physical function-related risk factors for falls among 56 breast cancer survivors (BCS) who had completed treatments. DESIGN This was a single-group longitudinal study. The multimodal PA intervention included aerobic, strengthening, and balance components. Physical function outcomes based on the 4-meter walk, chair stand, one-leg stance, tandem walk, and dynamic muscular endurance tests were assessed at 6-week pre-intervention (T1), baseline (T2), and post-intervention (T3). T1 to T2 and T2 to T3 were the control and intervention periods, respectively. RESULTS All outcomes, except the tandem walk test, significantly improved after the intervention period (P < 0.05), with no change detected after the control period (P > 0.05). Based on the falls risk criterion in the one-leg stance test, the proportion at risk for falls was significantly lower after the intervention period (P = 0.04), but not after the control period. CONCLUSIONS A community-based multimodal PA intervention for BCS may be efficacious in improving physical function-related risk factors for falls, and lowering the proportion of BCS at risk for falls based on specific physical function-related falls criteria. Further larger trials are needed to confirm these preliminary findings.
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Maringe C, Fowler H, Rachet B, Luque-Fernandez MA. Reproducibility, reliability and validity of population-based administrative health data for the assessment of cancer non-related comorbidities. PLoS One 2017; 12:e0172814. [PMID: 28263996 PMCID: PMC5338773 DOI: 10.1371/journal.pone.0172814] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 02/09/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Patients with comorbidities do not receive optimal treatment for their cancer, leading to lower cancer survival. Information on individual comorbidities is not straightforward to derive from population-based administrative health datasets. We described the development of a reproducible algorithm to extract the individual Charlson index comorbidities from such data. We illustrated the algorithm with 1,789 laryngeal cancer patients diagnosed in England in 2013. We aimed to clearly set out and advocate the time-related assumptions specified in the algorithm by providing empirical evidence for them. METHODS Comorbidities were assessed from hospital records in the ten years preceding cancer diagnosis and internal reliability of the hospital records was checked. Data were right-truncated 6 or 12 months prior to cancer diagnosis to avoid inclusion of potentially cancer-related comorbidities. We tested for collider bias using Cox regression. RESULTS Our administrative data showed weak to moderate internal reliability to identify comorbidities (ICC ranging between 0.1 and 0.6) but a notably high external validity (86.3%). We showed a reverse protective effect of non-cancer related Chronic Obstructive Pulmonary Disease (COPD) when the effect is split into cancer and non-cancer related COPD (Age-adjusted HR: 0.95, 95% CI:0.7-1.28 for non-cancer related comorbidities). Furthermore, we showed that a window of 6 years before diagnosis is an optimal period for the assessment of comorbidities. CONCLUSION To formulate a robust approach for assessing common comorbidities, it is important that assumptions made are explicitly stated and empirically proven. We provide a transparent and consistent approach useful to researchers looking to assess comorbidities for cancer patients using administrative health data.
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Affiliation(s)
- Camille Maringe
- Cancer survival group, Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Helen Fowler
- Cancer survival group, Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Bernard Rachet
- Cancer survival group, Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Miguel Angel Luque-Fernandez
- Cancer survival group, Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Williams GR, Mackenzie A, Magnuson A, Olin R, Chapman A, Mohile S, Allore H, Somerfield MR, Targia V, Extermann M, Cohen HJ, Hurria A, Holmes H. Comorbidity in older adults with cancer. J Geriatr Oncol 2016; 7:249-57. [PMID: 26725537 PMCID: PMC4917479 DOI: 10.1016/j.jgo.2015.12.002] [Citation(s) in RCA: 171] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 12/01/2015] [Accepted: 12/02/2015] [Indexed: 11/23/2022]
Abstract
Comorbidity is an issue of growing importance due to changing demographics and the increasing number of adults over the age of 65 with cancer. The best approach to the clinical management and decision-making in older adults with comorbid conditions remains unclear. In May 2015, the Cancer and Aging Research Group, in collaboration with the National Cancer Institute and the National Institute on Aging, met to discuss the design and implementation of intervention studies in older adults with cancer. A presentation and discussion on comorbidity measurement, interventions, and future research was included. In this article, we discuss the relevance of comorbidities in cancer, examine the commonly used tools to measure comorbidity, and discuss the future direction of comorbidity research. Incorporating standardized comorbidity measurement, relaxing clinical trial eligibility criteria, and utilizing novel trial designs are critical to developing a larger and more generalizable evidence base to guide the management of these patients. Creating or adapting comorbidity management strategies for use in older adults with cancer is necessary to define optimal care for this growing population.
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Affiliation(s)
- Grant R Williams
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | | | | | - Rebecca Olin
- University of California San Francisco, San Francisco, CA, USA
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Abstract
Answer questions and earn CME/CNE Comorbidity is common among cancer patients and, with an aging population, is becoming more so. Comorbidity potentially affects the development, stage at diagnosis, treatment, and outcomes of people with cancer. Despite the intimate relationship between comorbidity and cancer, there is limited consensus on how to record, interpret, or manage comorbidity in the context of cancer, with the result that patients who have comorbidity are less likely to receive treatment with curative intent. Evidence in this area is lacking because of the frequent exclusion of patients with comorbidity from randomized controlled trials. There is evidence that some patients with comorbidity have potentially curative treatment unnecessarily modified, compromising optimal care. Patients with comorbidity have poorer survival, poorer quality of life, and higher health care costs. Strategies to address these issues include improving the evidence base for patients with comorbidity, further development of clinical tools to assist decision making, improved integration and coordination of care, and skill development for clinicians. CA Cancer J Clin 2016;66:337-350. © 2016 American Cancer Society.
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Affiliation(s)
- Diana Sarfati
- Director, Cancer Control and Screening Research Group, University of Otago, Wellington, New Zealand
| | - Bogda Koczwara
- Senior Staff Specialist, Flinders Center for Innovation in Cancer, Flinders University, Adelaide, South Australia, Australia
| | - Christopher Jackson
- Senior Lecturer in Medicine, Department of Medicine, Dunedin School of Medicine, University of Otago, Wellington, New Zealand
- Consultant Medical Oncologist, Southern District Health Board, Dunedin, New Zealand
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Cetin K, Christiansen CF, Sværke C, Jacobsen JB, Sørensen HT. Survival in patients with breast cancer with bone metastasis: a Danish population-based cohort study on the prognostic impact of initial stage of disease at breast cancer diagnosis and length of the bone metastasis-free interval. BMJ Open 2015; 5:e007702. [PMID: 25926150 PMCID: PMC4420974 DOI: 10.1136/bmjopen-2015-007702] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES Since population-based data on prognostic factors affecting survival in patients with breast cancer with bone metastasis (BM) are currently limited, we conducted this nationwide retrospective cohort study to examine the prognostic role of disease stage at breast cancer diagnosis and length of BM-free interval (BMFI). SETTING Denmark. PARTICIPANTS 2427 women with a breast cancer diagnosis between 1997 and 2011 in the Danish Cancer Registry and a concurrent or subsequent BM diagnosis in the Danish National Registry of Patients. PRIMARY AND SECONDARY OUTCOME MEASURES Survival (crude) based on Kaplan-Meier method and mortality risk (crude and adjusted for age, year of diagnosis, estrogen receptor status and comorbidity) based on Cox proportional hazards regression analyses by stage of disease at breast cancer diagnosis and by length of BMFI (time from breast cancer to BM diagnosis), following patients from BM diagnosis until death, emigration or until 31 December 2012, whichever came first. RESULTS Survival decreased with more advanced stage of disease at the time of breast cancer diagnosis; risk of mortality during the first year following a BM diagnosis was over two times higher for those presenting with metastatic versus localised disease (adjusted HR=2.12 (95% CI 1.71 to 2.62)). With respect to length of BMFI, survival was highest in women with a BMFI <1 year (ie, in those who presented with BM at the time of breast cancer diagnosis or were diagnosed within 1 year). However, among patients with a BMFI ≥1 year, survival increased with longer BMFI (1-year survival: 39.9% (95% CI 36.3% to 43.6%) for BMFI 1 to <3 years and 52.6% (95% CI 47.4% to 57.6%) for BMFI ≥5 years). This pattern was also observed in multivariate analyses. CONCLUSIONS Stage of disease at breast cancer diagnosis and length of BMFI appear to be important prognostic factors for survival following BM.
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Affiliation(s)
- Karynsa Cetin
- Center for Observational Research, Amgen Inc., One Amgen Center Drive, Thousand Oaks, California, USA
| | | | - Claus Sværke
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Jacob Bonde Jacobsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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Rouaud A, Hanon O, Boureau AS, Chapelet GG, de Decker L. Comorbidities against quality control of VKA therapy in non-valvular atrial fibrillation: a French national cross-sectional study. PLoS One 2015; 10:e0119043. [PMID: 25789771 PMCID: PMC4366229 DOI: 10.1371/journal.pone.0119043] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 01/09/2015] [Indexed: 01/21/2023] Open
Abstract
Background Given the prevalence of non-valvular atrial fibrillation in the geriatric population, thromboembolic prevention by means of vitamin K antagonists (VKA) is one of the most frequent daily concerns of practitioners. The effectiveness and safety of treatment with VKA correlates directly with maximizing the time in therapeutic range, with an International Normalized Ratio (INR) of 2.0-3.0. The older population concentrates many of factors known to influence INR rate, particularly concomitant medications and concurrent medical conditions, also defined as comorbidities. Objective Determine whether a high burden on comorbidities, defined by a Charlson Comorbidity Index (CCI) of 3 or greater, is associated a lower quality of INR control. Study-Design Cross-sectional study. Settings French geriatric care units nationwide. Participants 2164 patients aged 80 and over and treated with vitamin K antagonists. Measurements Comorbidities were assessed using the Charlson Comorbidity Index (CCI). The recorded data included age, sex, falls, kidney failure, hemorrhagic event, VKA treatment duration, and the number and type of concomitant medications. Quality of INR control, defined as time in therapeutic range (TTR), was assessed using the Rosendaal method. Results 487 patients were identified the low-quality control of INR group. On multivariate logistic regression analysis, low-quality control of INR was independently associated with a CCI ≥3 (OR = 1.487; 95% CI [1.15; 1.91]). The other variables associated with low-quality control of INR were: hemorrhagic event (OR = 3.151; 95% CI [1.64; 6.07]), hospitalization (OR = 1.614, 95% CI [1.21; 2.14]). Conclusion An elevated CCI score (≥3) was associated with low-quality control of INR in elderly patients treated with VKA. Further research is needed to corroborate this finding.
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Affiliation(s)
- Agnes Rouaud
- Department of Geriatrics, EA 1156–12, Nantes University Hospital, Nantes, France
- * E-mail:
| | - Olivier Hanon
- Department of Geriatrics, Broca Hospital, Public Hospital of Paris, Paris, France
| | - Anne-Sophie Boureau
- Department of Geriatrics, EA 1156–12, Nantes University Hospital, Nantes, France
| | | | - Laure de Decker
- Department of Geriatrics, EA 1156–12, Nantes University Hospital, Nantes, France
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Johnston MC, Marks A, Crilly MA, Prescott GJ, Robertson LM, Black C. Charlson index scores from administrative data and case-note review compared favourably in a renal disease cohort. Eur J Public Health 2015; 25:391-6. [PMID: 25583040 DOI: 10.1093/eurpub/cku238] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The Charlson index is a widely used measure of comorbidity. The objective was to compare Charlson index scores calculated using administrative data to those calculated using case-note review (CNR) in relation to all-cause mortality and initiation of renal replacement therapy (RRT) in the Grampian Laboratory Outcomes Mortality and Morbidity Study (GLOMMS-1) chronic kidney disease cohort. METHODS Modified Charlson index scores were calculated using both data sources in the GLOMMS-1 cohort. Agreement between scores was assessed using the weighted Kappa. The association with outcomes was assessed using Poisson regression, and the performance of each was compared using net reclassification improvement. RESULTS Of 3382 individuals, median age 78.5 years, 56% female, there was moderate agreement between scores derived from the two data sources (weighted kappa 0.41). Both scores were associated with mortality independent of a number of confounding factors. Administrative data Charlson scores were more strongly associated with death than CNR scores using net reclassification improvement. Neither score was associated with commencing RRT. CONCLUSION Despite only moderate agreement, modified Charlson index scores from both data sources were associated with mortality. Neither was associated with commencing RRT. Administrative data compared favourably and may be superior to CNR when used in the Charlson index to predict mortality.
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Affiliation(s)
- Marjorie C Johnston
- 1 Chronic Disease Research Group, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, AB25 2ZD, UK 2 NHS Grampian, Summerfield House, Aberdeen, AB15 6RE, UK
| | - Angharad Marks
- 1 Chronic Disease Research Group, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - Michael A Crilly
- 1 Chronic Disease Research Group, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, AB25 2ZD, UK 2 NHS Grampian, Summerfield House, Aberdeen, AB15 6RE, UK
| | - Gordon J Prescott
- 1 Chronic Disease Research Group, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - Lynn M Robertson
- 1 Chronic Disease Research Group, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - Corri Black
- 1 Chronic Disease Research Group, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, AB25 2ZD, UK 2 NHS Grampian, Summerfield House, Aberdeen, AB15 6RE, UK
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Yurkovich M, Avina-Zubieta JA, Thomas J, Gorenchtein M, Lacaille D. A systematic review identifies valid comorbidity indices derived from administrative health data. J Clin Epidemiol 2015; 68:3-14. [DOI: 10.1016/j.jclinepi.2014.09.010] [Citation(s) in RCA: 209] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 07/19/2014] [Accepted: 09/03/2014] [Indexed: 01/08/2023]
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Eichorst MK, Allen RS, Halli-Tierney AD, Scogin F, Kvale EA. Health Care Communication and Agreement and Disagreement About Symptoms Within the Context of Multimorbidity. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2015; 11:346-366. [PMID: 26654065 DOI: 10.1080/15524256.2015.1116484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Informal caregivers for older adults often act as medical 'proxies' based on their assumed knowledge of the care recipient's illness-related symptoms. Differences between symptom descriptions given by care recipients and caregivers, however, raise questions about the validity of proxy reports. Community-dwelling caregivers and their care recipients with chronic, multi-morbid conditions revealed similar numbers of symptoms reported as well as average symptom distress. Dyads with care recipients who scored higher on negative affect were more likely to have significantly lower. Results suggested the possibility of identifying and intervening with dyads who may be 'at-risk' for divergent symptom reporting. This awareness may increase the ability to engage in informed and shared medical decision making throughout the illness trajectory.
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Affiliation(s)
- Morgan K Eichorst
- a Department of Psychology , Alabama Research Institute on Aging, The University of Alabama , Tuscaloosa , Alabama , USA
| | - Rebecca S Allen
- a Department of Psychology , Alabama Research Institute on Aging, The University of Alabama , Tuscaloosa , Alabama , USA
| | - Anne D Halli-Tierney
- b College of Community Health Sciences and Alabama Research Institute on Aging , The University of Alabama , Tuscaloosa , Alabama , USA
| | - Forrest Scogin
- c Department of Psychology and Alabama Research Institute on Aging, The University of Alabama , Tuscaloosa , Alabama , USA
| | - Elizabeth A Kvale
- d Center for Palliative and Supportive Care , University of Alabama at Birmingham, and Birmingham-Atlanta Geriatric Research Education and Clinical Center, Veterans Administration Medical Center , Birmingham , Alabama , USA
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Daskivich TJ, Litwin MS, Saigal C. Reply to Charlson score and competing mortality. Cancer 2014; 120:4003-4. [PMID: 25209698 DOI: 10.1002/cncr.28955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 07/09/2014] [Indexed: 11/12/2022]
Affiliation(s)
- Timothy J Daskivich
- Department of Urology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
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Sinha P, Kallogjeri D, Piccirillo JF. Assessment of comorbidities in surgical oncology outcomes. J Surg Oncol 2014; 110:629-35. [DOI: 10.1002/jso.23723] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Accepted: 06/11/2014] [Indexed: 12/31/2022]
Affiliation(s)
- Parul Sinha
- Department of Otolaryngology-Head and Neck Surgery; Washington University School of Medicine; St. Louis Missouri
| | - Dorina Kallogjeri
- Department of Otolaryngology-Head and Neck Surgery; Washington University School of Medicine; St. Louis Missouri
| | - Jay F. Piccirillo
- Department of Otolaryngology-Head and Neck Surgery; Washington University School of Medicine; St. Louis Missouri
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Izano M, Satariano WA, Tammemagi MC, Ragland D, Moore DH, Allen E, Naeim A, Sehl ME, Hiatt RA, Kerlikowske K, Sofrygin O, Braithwaite D. Long-term outcomes among African-American and white women with breast cancer: what is the impact of comorbidity? J Geriatr Oncol 2014; 5:266-75. [PMID: 24613574 DOI: 10.1016/j.jgo.2014.02.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 01/08/2014] [Accepted: 02/18/2014] [Indexed: 11/20/2022]
Abstract
OBJECTIVES We examined the association between comorbidity and long-term mortality from breast cancer and other causes among African-American and white women with breast cancer. METHODS A total of 170 African-American and 829 white women aged 40-84years were followed for up to 28years with median follow-up of 11.3years in the Health and Functioning in Women (HFW) study. The impact of the Charlson Comorbidity Score (CCS) in the first few months following breast cancer diagnosis on the risk of mortality from breast cancer and other causes was examined using extended Cox models. RESULTS Median follow-up was significantly shorter for African-American women than their white counterparts (median 8.5years vs. 12.3years). Compared to white women, African-American women had significantly fewer years of education, greater body mass index, were more likely to have functional limitations and later stage at breast cancer diagnosis, and fewer had adequate financial resources (all P<0.05). Proportionately more African-American women died of breast cancer than white women (37.1% vs. 31.4%, P=0.15). A positive and statistically significant time-varying effect of the Charlson Comorbidity Score (CCS) on other-cause mortality persisted throughout the first 5years of follow-up (P<0.001) but not for its remainder. CONCLUSIONS Higher CCS was associated with increased risk of other-cause mortality, but not breast cancer specific mortality; the association did not differ among African-American and white women.
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Affiliation(s)
- Monika Izano
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | | | - Martin C Tammemagi
- Department of Community Health Sciences, Brock University, St. Catharines, Ontario, Canada
| | - David Ragland
- School of Public Health, University of California, Berkeley, CA, USA
| | - Dan H Moore
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Elaine Allen
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Arash Naeim
- Division of Hematology-Oncology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Mary E Sehl
- Division of Hematology-Oncology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Robert A Hiatt
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA; Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
| | - Karla Kerlikowske
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Oleg Sofrygin
- School of Public Health, University of California, Berkeley, CA, USA
| | - Dejana Braithwaite
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA; Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA.
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Determinants of newly diagnosed comorbidities among breast cancer survivors. J Cancer Surviv 2014; 8:384-93. [DOI: 10.1007/s11764-013-0338-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 12/18/2013] [Indexed: 12/30/2022]
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Braithwaite D, Zhu W, Hubbard RA, O'Meara ES, Miglioretti DL, Geller B, Dittus K, Moore D, Wernli KJ, Mandelblatt J, Kerlikowske K. Screening outcomes in older US women undergoing multiple mammograms in community practice: does interval, age, or comorbidity score affect tumor characteristics or false positive rates? J Natl Cancer Inst 2013; 105:334-41. [PMID: 23385442 DOI: 10.1093/jnci/djs645] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Uncertainty exists about the appropriate use of screening mammography among older women because comorbid illnesses may diminish the benefit of screening. We examined the risk of adverse tumor characteristics and false positive rates according to screening interval, age, and comorbidity. Methods From January 1999 to December 2006, data were collected prospectively on 2993 older women with breast cancer and 137 949 older women without breast cancer who underwent mammography at facilities that participated in a data linkage between the Breast Cancer Surveillance Consortium and Medicare claims. Women were aged 66 to 89 years at study entry to allow for measurement of 1 year of preexisting illnesses. We used logistic regression analyses to calculate the odds of advanced (IIb, III, IV) stage, large (>20 millimeters) tumors, and 10-year cumulative probability of false-positive mammography by screening frequency (1 vs 2 years), age, and comorbidity score. The comorbidity score was derived using the Klabunde approximation of the Charlson score. All statistical tests were two-sided. Results Adverse tumor characteristics did not differ statistically significantly by comorbidity, age, or interval. Cumulative probability of a false-positive mammography result was higher among annual screeners than biennial screeners irrespective of comorbidity: 48.0% (95% confidence interval [CI] = 46.1% to 49.9%) of annual screeners aged 66 to 74 years had a false-positive result compared with 29.0% (95% CI = 28.1% to 29.9%) of biennial screeners. Conclusion Women aged 66 to 89 years who undergo biennial screening mammography have similar risk of advanced-stage disease and lower cumulative risk of a false-positive recommendation than annual screeners, regardless of comorbidity.
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Affiliation(s)
- Dejana Braithwaite
- Department of Epidemiology and Biostatistics, University of California, San Francisco, 185 Berry St, Ste 5700, San Francisco, CA 94107, USA.
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Raphael JL, Tran XG, Mueller BU, Giardino AP. Integration of Administrative Data and Chart Review for Reporting Health Care Utilization Among Children With Sickle Cell Disease. SAGE OPEN 2013; 3:2158244013482470. [PMID: 24077363 PMCID: PMC3784016 DOI: 10.1177/2158244013482470] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Health care utilization of children with sickle cell disease (SCD) has been well documented due to an increase in the use of administrative data sets. While use of such data sources is relatively efficient and low cost, questions remain as to whether they provide sufficient information to fully characterize health care use. The aim of this study was to determine whether administrative data have the capacity to fully assess health care utilization among children with SCD. We studied the health care utilization of 154 low-income children with SCD in a managed care organization combining administrative data and medical record review. In our comparison, we found that administrative claims provided key information on the scope and location of health service use and that sole reliance on medical record review may undercount unique members and encounters.
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Affiliation(s)
| | | | | | - Angelo P. Giardino
- Baylor College of Medicine, Houston, TX, USA
- Texas Children’s Health Plan, Houston, USA
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Simon TG, Beland MD, Machan JT, DiPetrillo T, Dupuy DE. Charlson Comorbidity Index predicts patient outcome, in cases of inoperable non-small cell lung cancer treated with radiofrequency ablation. Eur J Radiol 2012; 81:4167-72. [DOI: 10.1016/j.ejrad.2012.06.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Revised: 06/13/2012] [Accepted: 06/14/2012] [Indexed: 12/25/2022]
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Nadpara PA, Madhavan SS, Khanna R, Smith M, Miller LA. Patterns of cervical cancer screening, diagnosis, and follow-up treatment in a state Medicaid fee-for-service population. Popul Health Manag 2012; 15:362-71. [PMID: 22788858 DOI: 10.1089/pop.2011.0093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Despite being a screening-amenable cancer, cervical cancer is the third most common genital cancer among white women and the most common among African American women. The study objective was to use administrative claims data for CC disease surveillance among recipients enrolled in a state Medicaid fee-for-service (FFS) program. West Virginia (WV) Medicaid FFS administrative claims data for female recipients aged 21-64 years from 2003 to 2008 were used for this study. All medical and prescription claims were aggregated to reflect each recipient's medical care and prescription drug utilization. The yearly prevalence of Pap smear testing declined from 23.9% in 2003 to 15.8% in 2008 in the Medicaid FFS population. During the 6-year study period, persistence with Pap smear testing was low; 41.8% of recipients received no Pap smear testing. Only 73.1% of recipients received Pap smear testing during the year prior to their CC or precancerous cervical lesions (PCL) diagnosis. The likelihood of a CC diagnosis increased with a decrease in Pap smear testing persistence. Only 10.1% of recipients received appropriate follow-up care following a diagnosis of high-grade PCL; only 31.5% of the recipients received appropriate follow-up care for low-grade PCL diagnosis. Although CC preventive services such as screening and PCL follow-up care are covered under Medicaid programs, underutilization of these services by recipients in the Medicaid FFS population is a concern. Results of this study emphasize the need to address disparities in screening and appropriate PCL follow-up care among recipients in the Medicaid FFS population.
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Affiliation(s)
- Pramit Amrutlal Nadpara
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV 26506, USA.
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Braithwaite D, Moore DH, Satariano WA, Kwan ML, Hiatt RA, Kroenke C, Caan BJ. Prognostic impact of comorbidity among long-term breast cancer survivors: results from the LACE study. Cancer Epidemiol Biomarkers Prev 2012; 21:1115-25. [PMID: 22573797 DOI: 10.1158/1055-9965.epi-11-1228] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Little is known about the long-term impact of comorbidity among women with breast cancer. METHODS We studied a prospective cohort of 2,272 women with breast cancer, who were recruited following initial breast cancer treatment. Associations of the Charlson comorbidity index (CCI) and hypertension with survival were evaluated in delayed entry Cox proportional hazards models. RESULTS During a median follow-up of nine years, higher CCI scores were independently associated with an increased risk of death from all causes [HR, 1.32; 95% confidence interval (CI), 1.13-1.54] and from nonbreast cancer causes (HR, 1.55; 95% CI, 1.19-2.02), but not from breast cancer (HR, 1.14; 95% CI, 0.93-1.41). Hypertension was independently associated with an increased risk of death from all causes (HR, 1.55; 95% CI, 1.20-1.99), from nonbreast cancer causes (HR, 1.67; 95% CI, 1.10-2.54), and from breast cancer (HR, 1.47; 95% CI, 1.03-2.09), but these associations were no longer significant after adjustment for antihypertensive medication. The relationship between the CCI and overall survival was the strongest among women with stage I disease (stage I, HR, 1.65; 95% CI, 1.26-2.16 vs. stage III, HR, 0.53; 95% CI, 0.23-1.25). CONCLUSION The CCI was independently associated with lower overall and nonbreast cancer survival, but not with breast cancer-specific survival. IMPACT Comorbidity may play an important role in breast cancer outcomes.
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Affiliation(s)
- Dejana Braithwaite
- Department of Epidemiology and Biostatistics and Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA 94107, USA.
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Safety and outcome of chemoradiotherapy in elderly patients with rectal cancer: results from two French tertiary centres. Dig Liver Dis 2012; 44:350-4. [PMID: 22119617 DOI: 10.1016/j.dld.2011.10.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2011] [Revised: 10/17/2011] [Accepted: 10/20/2011] [Indexed: 12/11/2022]
Abstract
BACKGROUND The risks of chemoradiotherapy in elderly patients with rectal cancer have not yet been well-characterised. METHODS We retrospectively reviewed the charts of patients with rectal cancer over 70 years old who were treated with chemoradiotherapy in two French university hospitals. RESULTS A total of 125 patients were evaluated. Mean age was 75.1 ± 4.1 years and ranged from 70 to 90 years. Adverse effects ≥ grade 2 were observed in 32% of the patients and adverse effects ≥ grade 3 in 15%. Dose reduction for toxicity was performed in 18% of the patients and chemoradiotherapy discontinuation was necessary in 9%. Postoperative morbidity was 16% with two treatment-related deaths. Two-year survival rate was 84%. No variables had any influence on treatment-related adverse events. CONCLUSIONS In selected elderly patients, chemoradiotherapy is well-tolerated, without any significant increase in adverse events, and the results are similar to those recorded in younger patients.
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Lim JH, Park JY. The impact of comorbidity (the Charlson Comorbidity Index) on the health outcomes of patients with the acute myocardial infarction(AMI). HEALTH POLICY AND MANAGEMENT 2011. [DOI: 10.4332/kjhpa.2011.21.4.541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Land LH, Dalton SO, Jensen MB, Ewertz M. Impact of comorbidity on mortality: a cohort study of 62,591 Danish women diagnosed with early breast cancer, 1990-2008. Breast Cancer Res Treat 2011; 131:1013-20. [PMID: 22002567 DOI: 10.1007/s10549-011-1819-1] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Accepted: 10/01/2011] [Indexed: 11/30/2022]
Abstract
The incidence of breast cancer, as well as other chronic disease, increases with age, older breast cancer patients being more likely than younger to suffer from other diseases at time of diagnosis. Our objective was to assess the effect of comorbidity on mortality after early breast cancer. 62,591 women diagnosed with early breast cancer 1990-2008 were identified using the Danish Breast Cancer Cooperative Group Registry. Data were linked to the Danish National Patient Register and the Danish Register of Causes of Death. Main outcome measures were mortality from all causes, breast cancer, and non-breast cancer causes in relation to Charlson comorbidity index (CCI). Compared with patients without comorbidity (CCI 0), the presence of comorbidity increased the risk of dying from breast cancer as well as other causes with adjusted hazard ratios (HRs) for all-cause mortality of 1.45 (CI 95% 1.40-1.51) for CCI 1, 1.52 (95% CI 1.45-1.60) for CCI 2, and 2.21 (95% CI 2.08-2.35) for CCI 3+. Equivalent HRs for breast cancer-specific mortality were 1.30 (95% CI, 1.24-1.36) for CCI 1, 1.31 (95% CI 1.23-1.39) for CCI 2, and 1.79 (95% CI, 1.66-1.93) for CCI 3+ (all P values < 0.0001). For patients with CCI 0, 5-year overall survival increased over time from 72.5% (95% CI, 71.7-73.3%) in 1990-1994 to 81.6% (95% CI, 80.9-82.2) in 2000-2004, whereas the 5-year overall survival remained stable around 43% among the patients with CCI 3+. This population-based cohort study shows that compared with patients without comorbidity, the risk of dying from breast cancer as well as other causes increased significantly with increasing CCI score. While survival improved over time for patients without comorbidity, no improvement was seen among patients with severe comorbidity (CCI 3+).
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Affiliation(s)
- Lotte Holm Land
- Department of Oncology, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark.
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Patnaik JL, Byers T, Diguiseppi C, Denberg TD, Dabelea D. The influence of comorbidities on overall survival among older women diagnosed with breast cancer. J Natl Cancer Inst 2011; 103:1101-11. [PMID: 21719777 DOI: 10.1093/jnci/djr188] [Citation(s) in RCA: 220] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Previous studies have shown that summary measures of comorbid conditions are associated with decreased overall survival in breast cancer patients. However, less is known about associations between specific comorbid conditions on the survival of breast cancer patients. METHODS The Surveillance, Epidemiology, and End Results-Medicare database was used to identify primary breast cancers diagnosed from 1992 to 2000 among women aged 66 years or older. Inpatient, outpatient, and physician visits within the Medicare system were searched to determine the presence of 13 comorbid conditions present at the time of diagnosis. Overall survival was estimated using age-specific Kaplan-Meier curves, and mortality was estimated using Cox proportional hazards models adjusted for age, race and/or ethnicity, tumor stage, cancer prognostic markers, and treatment. All statistical tests were two-sided. RESULTS The study population included 64,034 patients with breast cancer diagnosed at a median age of 75 years. None of the selected comorbid conditions were identified in 37,306 (58%) of the 64,034 patients in the study population. Each of the 13 comorbid conditions examined was associated with decreased overall survival and increased mortality (from prior myocardial infarction, adjusted hazard ratio [HR] of death = 1.11, 95% CI = 1.03 to 1.19, P = .006; to liver disease, adjusted HR of death = 2.32, 95% CI = 1.97 to 2.73, P < .001). When patients of age 66-74 years were stratified by stage and individual comorbidity status, patients with each comorbid condition and a stage I tumor had similar or poorer overall survival compared with patients who had no comorbid conditions and stage II tumors. CONCLUSIONS In a US population of older breast cancer patients, 13 individual comorbid conditions were associated with decreased overall survival and increased mortality.
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Affiliation(s)
- Jennifer L Patnaik
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, CO 80045, USA.
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Abouassaly R, Finelli A, Tomlinson GA, Urbach DR, Alibhai SMH. How often are patients with diabetes or hypertension being treated with partial nephrectomy for renal cell carcinoma? A population-based analysis. BJU Int 2011; 108:1806-12. [PMID: 21599823 DOI: 10.1111/j.1464-410x.2011.10254.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
UNLABELLED What's known on the subject? and What does the study add? We know that a major benefit of partial nephrectomy (PN) over radical nephrectomy (RN) is greater preservation of kidney function. Emerging evidence also suggests that chronic kidney disease (CKD) correlates with survival, likely as a result of increased cardiovascular morbidity. We also know that Diabetes Mellitus (DM) followed by Hypertension (HTN) are the two most frequent causes of end-stage renal disease (ESRD). Given the strong association between renal functional decline and the surgical treatment of small renal masses, one would expect utilization of PN in patients with HTN or DM to be high, however minimal data exist on PN use in these populations. We are thus unable to determine whether these patients are being managed optimally. Our large study demonstrates that PN is being underutilized in patients at risk for CKD, particularly patients with Diabetes Mellitus and Hypertension. Unlike previously published reports, our population-level study provides a description of the landscape of care for patients with renal masses in general practice, and does not simply reflect treatment patterns at tertiary referral centers. The finding of low PN use in patients at risk for CKD deserves further study. Future studies should focus on determining the specific factors contributing to PN underutilization in these susceptible patients, as well as developing clinical tools to reliably identify those patients in whom the benefits of PN outweigh the risks. OBJECTIVE • To determine partial nephrectomy (PN) use in patients at risk of chronic kidney disease (CKD), such as those with diabetes mellitus (DM) and hypertension (HTN). PATIENTS AND METHODS • We conducted a national, population-based, retrospective, observational study using the Canadian Institute for Health Information Discharge Abstract Database. • We included all patients treated surgically for renal cell carcinoma from 1 April 1998 to 31 March 2008. • Patients with DM and HTN were identified using specific diagnosis codes. • The proportions of patients treated with PN were compared in patients with and without DM and HTN using multivariable logistic regression adjusting for covariates. RESULTS • A total of 24,579 patients were treated for a renal mass; of these, 4292 (17.5%) underwent PN. • In our sample, 5613 (22.8%) patients were identified as having HTN, and 2738 (11.1%) were identified as having DM. • PN was used in 17.3% of patients with HTN compared to 17.5% of those without HTN, whereas, in patients with DM, PN was used in 18.6% compared to 17.3% of patients without DM. • After adjusting for covariates, neither HTN, nor DM were found to be independently associated with increased PN use (odds ratio, 1.07; 95% CI, 0.98-1.16 and odds ratio, 1.08; 95% CI, 0.96-1.20, respectively). CONCLUSIONS • In this contemporary national analysis, PN appears to be underutilized in DM and HTN, despite their known relationship with chronic renal failure. • Further studies are needed to elucidate the specific factors contributing to PN underutilization in these susceptible patients.
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Affiliation(s)
- Robert Abouassaly
- Urological Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH 44106, USA.
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Chong WF, Ding YY, Heng BH. A comparison of comorbidities obtained from hospital administrative data and medical charts in older patients with pneumonia. BMC Health Serv Res 2011; 11:105. [PMID: 21586172 PMCID: PMC3112394 DOI: 10.1186/1472-6963-11-105] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Accepted: 05/18/2011] [Indexed: 02/01/2023] Open
Abstract
Background The use of comorbidities in risk adjustment for health outcomes research is frequently necessary to explain some of the observed variations. Medical charts reviews to obtain information on comorbidities is laborious. Increasingly, electronic health care databases have provided an alternative for health services researchers to obtain comorbidity information. However, the rates obtained from databases may be either over- or under-reported. This study aims to (a) quantify the agreement between administrative data and medical charts review across a set of comorbidities; and (b) examine the factors associated with under- or over-reporting of comorbidities by administrative data. Methods This is a retrospective cross-sectional study of patients aged 55 years and above, hospitalized for pneumonia at 3 acute care hospitals. Information on comorbidities were obtained from an electronic administrative database and compared with information from medical charts review. Logistic regression was performed to identify factors that were associated with under- or over-reporting of comorbidities by administrative data. Results The prevalence of almost all comorbidities obtained from administrative data was lower than that obtained from medical charts review. Agreement between comorbidities obtained from medical charts and administrative data ranged from poor to very strong (kappa 0.01 to 0.78). Factors associated with over-reporting of comorbidities were increased length of hospital stay, disease severity, and death in hospital. In contrast, those associated with under-reporting were number of comorbidities, age, and hospital admission in the previous 90 days. Conclusions The validity of using secondary diagnoses from administrative data as an alternative to medical charts for identification of comorbidities varies with the specific condition in question, and is influenced by factors such as age, number of comorbidities, hospital admission in the previous 90 days, severity of illness, length of hospitalization, and whether inhospital death occurred. These factors need to be taken into account when relying on administrative data for comorbidity information.
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Affiliation(s)
- Wai Fung Chong
- Health Services and Outcomes Research, National Healthcare Group, 6 Commonwealth Lane, #04-01/02 GMTI Building, Singapore 149547.
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Comorbidity and survival after early breast cancer. A review. Crit Rev Oncol Hematol 2011; 81:196-205. [PMID: 21536452 DOI: 10.1016/j.critrevonc.2011.03.001] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Revised: 02/21/2011] [Accepted: 03/02/2011] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Survival after breast cancer is determined by disease related factors such as stage at diagnosis, patient characteristics, e.g., age, and treatment. AIM To review evidence published during the last ten years on the effect of comorbidity on survival after early breast cancer. METHODS A search in Pubmed with keywords, breast neoplasm, comorbidity, and survival, was performed. A total of 18 studies published between 2000 and August 2010 was included in this review. RESULTS All 18 studies demonstrated that comorbidity had a significant impact on survival after breast cancer with poorer survival among patients with one or more comorbid conditions. The effect of comorbidity persisted after adjustment for age at diagnosis and stage of disease. Older patients with comorbidity were less likely to receive therapy according to guidelines. CONCLUSION Presence of comorbidity at diagnosis is an important prognostic factor in early breast cancer, irrespective of age and stage of disease.
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Survival in breast cancer patients with bone metastases and skeletal-related events: a population-based cohort study in Denmark (1999–2007). Breast Cancer Res Treat 2011; 129:495-503. [DOI: 10.1007/s10549-011-1475-5] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2010] [Accepted: 03/19/2011] [Indexed: 10/18/2022]
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Watkins K, Horvitz-Lennon M, Caldarone LB, Shugarman LR, Smith B, Mannle TE, Kivlahan DR, Pincus HA. Developing medical record-based performance indicators to measure the quality of mental healthcare. J Healthc Qual 2011; 33:49-66; quiz 66-7. [PMID: 21199073 DOI: 10.1111/j.1945-1474.2010.00128.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Recent attention has focused on validity and feasibility of different approaches to developing performance indicators for the purposes of quality improvement and value-based purchasing. This paper presents the methodology used to develop a comprehensive set of performance indicators that will be used for a national evaluation of the mental healthcare provided by the Veterans Health Administration. The paper report on the indicators' technical specifications and the United States Public Health System Task Force defined strength of supporting evidence. Indicators were reviewed iteratively for meaningfulness, utility, feasibility, and supporting evidence until a final set of measures of acceptable validity and feasibility was produced with technical specifications. Fifty-seven mental health performance indicators that use information from both the medical record and administrative data (hybrid indicators) and 31 administrative-data only indicators are presented. Of the 57 hybrid indicators, 13 indicators are supported by Agency for Healthcare Research and Quality grade I evidence, 5 indicators are grade II, and 39 indicators are grade III. This paper describes the methodology used to develop 88 performance indicators of the quality of mental health and substance abuse treatment, and presents the technical specifications associated with each indicator.
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Watkins KE, Keyser DJ, Smith B, Mannle TE, Kivlahan DR, Paddock SM, Mattox T, Horvitz-Lennon M, Pincus HA. Transforming Mental Healthcare in the Veterans Health Administration: A Model for Measuring Performance to Improve Access, Quality, and Outcomes. J Healthc Qual 2010; 32:33-42; quiz 42-3. [DOI: 10.1111/j.1945-1474.2010.00109.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Almoudaris AM, Burns EM, Bottle A, Aylin P, Darzi A, Faiz O. A colorectal perspective on voluntary submission of outcome data to clinical registries. Br J Surg 2010; 98:132-9. [PMID: 21136567 DOI: 10.1002/bjs.7301] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2010] [Indexed: 11/09/2022]
Abstract
BACKGROUND The aim of the study was to identify outcome differences amongst patients undergoing resection of colorectal cancer at English National Health Service trusts using Hospital Episode Statistics (HES). A comparison was undertaken of trusts that submitted and those that did not submit, or submitted only poorly, voluntarily to a colorectal clinical registry, the National Bowel Cancer Audit Programme (NBOCAP). METHODS The NBOCAP data set was used to classify trusts according to submitter status. HES data were used for outcome analysis. Data for major resections of colorectal cancer performed between 1 August 2007 and 31 July 2008 were obtained from HES. Trusts not submitting data to NBOCAP and those submitting less than 10 per cent of their total workload were termed 'non-submitters'. HES data for 30-day mortality, length of stay and readmission rates were compared according to submitter and non-submitter status in multifactorial analyses. RESULTS A total of 17,722 patients were identified from HES for inclusion. Unadjusted 30-day in-hospital mortality rates were higher in non-submitting than in submitting trusts (5·2 versus 4·0 per cent; P = 0·005). Submitter status was independently associated with reduced 30-day mortality (odds ratio 0·76, 95 per cent confidence interval 0·61 to 0·96; P = 0·021) in regression analysis. CONCLUSION A higher postoperative mortality rate following resection of colorectal cancer was found in trusts that do not voluntarily report data to NBOCAP. Implications regarding the voluntary nature of submission to such registries should be reviewed if they are to be used for outcome benchmarking.
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Affiliation(s)
- A M Almoudaris
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, St Mary's Hospital, Praed Street, London W2 1NY, UK
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Seo HJ, Yoon SJ, Lee SI, Lee KS, Yun YH, Kim EJ, Oh IH. A comparison of the Charlson comorbidity index derived from medical records and claims data from patients undergoing lung cancer surgery in Korea: a population-based investigation. BMC Health Serv Res 2010; 10:236. [PMID: 20704757 PMCID: PMC2936375 DOI: 10.1186/1472-6963-10-236] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Accepted: 08/13/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Calculating the Charlson comorbidity index (CCI) from medical records is a time-consuming and expensive process. The objectives of this study are to 1) measure agreement between medical record and claims data for CCI in lung cancer patients and 2) predict health outcomes of lung cancer patients based on CCIs from both data sources. METHODS We studied 392 patients who underwent surgery for pathologic stages I-III of lung cancer. The kappa value was used to measure the agreement between the 17 comorbidities of the CCI prevalence obtained from medical records and claims data. Multiple linear regression analyses were used to evaluate the relationships between CCI and length of stay and reimbursement cost. RESULTS Out of 17 comorbidities identified in the Charlson comorbidity index, ten had a higher prevalence, four had a lower prevalence and three had a similar prevalence in claims data to those of medical records. The kappa values calculated from the two databases ranged from 0.093 to 0.473 for nine comorbidities. In predicting length of stay and reimbursement cost after surgical resection for lung cancer patients, the CCI scores derived from both the medical records and claims data were not statistically significant. CONCLUSIONS Poor agreement between medical record data and claims data may result from different motivations for collecting data. Further studies are needed to determine an appropriate method for predicting health outcomes based on these data sources.
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Affiliation(s)
- Hyun-Ju Seo
- Department of Nursing, College of Medicine, Chosun University, Gwangju, Korea
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Leal J, Laupland K. Validity of ascertainment of co-morbid illness using administrative databases: a systematic review. Clin Microbiol Infect 2010; 16:715-21. [DOI: 10.1111/j.1469-0691.2009.02867.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Silliman RA. When cancer in older adults is undermanaged: the breast cancer story. J Am Geriatr Soc 2010; 57 Suppl 2:S259-61. [PMID: 20122024 DOI: 10.1111/j.1532-5415.2009.02506.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Age is the most important risk factor for breast cancer; age is also a risk factor for undermanagement of breast cancer. One thousand eight hundred fifty-nine women aged 65 and older with early-stage breast cancer were studied, and it was found that undermanagement is a risk factor for recurrence and for dying of breast cancer. Although conservative treatment is probably warranted in patients with tumors having excellent prognostic characteristics and in women with limited life expectancies, standard treatment is needed for the majority of older women if the disproportionate burden of breast cancer in this age group is to be reduced. Better strategies are needed for identifying those most likely to benefit from standard treatment and from systematic surveillance for recurrence. In this regard, collaboration between oncologists and primary care physicians is essential for achieving high-quality care and outcomes in this vulnerable group of patients.
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Woo HK, Park JH, Kang HS, Kim SY, Lee SI, Nam HH. Charlson Comorbidity Index as a Predictor of Long-Term Survival after Surgery for Breast Cancer: A Nationwide Retrospective Cohort Study in South Korea. J Breast Cancer 2010. [DOI: 10.4048/jbc.2010.13.4.409] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Hye Kyung Woo
- Cancer Policy Branch, National Cancer Control Institute, Goyang, Korea
| | - Jong Hyock Park
- Cancer Policy Branch, National Cancer Control Institute, Goyang, Korea
| | - Han Sung Kang
- Center for Breast Cancer, National Cancer Center, Goyang, Korea
| | - So Young Kim
- Cancer Policy Branch, National Cancer Control Institute, Goyang, Korea
| | - Sang Il Lee
- Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyung Ho Nam
- Cancer Biostatistics Branch, Division of Cancer Epidemiology & Management, National Cancer Center, Goyang, Korea
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Butler AM, Olsen MA, Merz LR, Guth RM, Woeltje KF, Camins BC, Fraser VJ. Attributable costs of enterococcal bloodstream infections in a nonsurgical hospital cohort. Infect Control Hosp Epidemiol 2010; 31:28-35. [PMID: 19951200 PMCID: PMC3608393 DOI: 10.1086/649020] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Vancomycin-resistant Enterococcus (VRE) bloodstream infections (BSIs) are associated with increased morbidity and mortality. OBJECTIVE To determine the hospital costs and length of stay attributable to VRE BSI and vancomycin-sensitive Enterococcus (VSE) BSI and the independent effect of vancomycin resistance on hospital costs. METHODS A retrospective cohort study was conducted of 21,154 nonsurgical patients admitted to an academic medical center during the period from 2002 through 2003. Using administrative data, attributable hospital costs (adjusted for inflation to 2007 US dollars) and length of stay were estimated with multivariate generalized least-squares (GLS) models and propensity score-matched pairs. RESULTS The cohort included 94 patients with VRE BSI and 182 patients with VSE BSI. After adjustment for demographics, comorbidities, procedures, nonenterococcal BSI, and early mortality, the costs attributable to VRE BSI were $4,479 (95% confidence interval [CI], $3,500-$5,732) in the standard GLS model and $4,036 (95% CI, $3,170-$5,140) in the propensity score-weighted GLS model, and the costs attributable to VSE BSI were $2,250 (95% CI, $1,758-$2,880) in the standard GLS model and $2,023 (95% CI, $1,588-$2,575) in the propensity score-weighted GLS model. The median values of the difference in costs between matched pairs were $9,949 (95% CI, $1,579-$24,693) for VRE BSI and $5,282 (95% CI, $2,042-$8,043) for VSE BSI. The costs attributable to vancomycin resistance were $1,713 (95% CI, $1,338-$2,192) in the standard GLS model and $1,546 (95% CI, $1,214-$1,968) in the propensity score-weighted GLS model. Depending on the statistical method used, attributable length of stay estimates ranged from 2.2 to 3.5 days for patients with VRE BSI and from 1.1 to 2.2 days for patients with VSE BSI. CONCLUSIONS VRE BSI and VSE BSI were independently associated with increased hospital costs and increased length of stay. Vancomycin resistance was associated with increased costs.
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Affiliation(s)
- Anne M Butler
- Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri, USA.
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