European Journal of Internal Medicine
Volume 18, Issue 5 , Pages 359-368 , September 2007

Co-morbidity does not reflect complexity in internal medicine patients

  • Roberto Nardi

      Affiliations

    • U.O.C. di Medicina Interna-Azienda USL di Bologna, Ospedale G. Dossetti di Bazzano, Italy
    • Corresponding Author InformationCorresponding author. Viale dei Martiri 10 b, 40053 Bazzano (BO) Italy. Tel.: +39 051838862; fax: +39 051838829.
    • ,
  • Giovanni Scanelli

      Affiliations

    • U.O.C. di Medicina Interna Ospedaliera-Azienda Ospedaliero Universitaria di Ferrara “Arcispedale Sant'Anna”, Italy
    • ,
  • Salvatore Corrao

      Affiliations

    • Dipartimento Biomedico di Medicina Interna e Specialistica-Università di Palermo, Italy
    • ,
  • Ido Iori

      Affiliations

    • U.O.C. di Medicina Interna e Centro Emostasi e Trombosi-Azienda Ospedaliera di Reggio Emilia “Arcispedale Santa Maria Nuova”, Italy
    • ,
  • Giovanni Mathieu

      Affiliations

    • U.O.C. di Medicina Interna-Ospedale E. Agnelli di Pinerolo Torino, Italy
    • ,
  • Roberto Cataldi Amatrian

      Affiliations

    • General Secretary of International College of Internal Medicine-“Universidad del Salvador”, Buenos Aires, Argentina

Received 7 June 2006 ,Revised 6 December 2006 ,Accepted 9 May 2007.

References 

  1. Bellis P. per il Gruppo Minerva. Progetto Minerva: origini, metodologie, obiettivi. Torino: Centro Scientifico Editore; 2004;
  2. European Federation of Internal Medicine . Just what is an internist? An identification of the specialist in the diseases of adults composed of six thumbnail definitions. Vnit lek. 2001;47:416–417
  3. Barr DP. The responsibilities of the internist. Ann Intern Med. 1947;27:195–201
  4. Kucharz EJ. Internal medicine: yesterday, today, and tomorrow. Part II. Definition and development in the 20th century. Eur J Int Med. 2003;14:272–274
  5. Akker M, van den Buntinx F, Knottnerus JA. Comorbidity or multimorbidity: what's in a name? A review of literature. Eur J Gen Pract. 1996;2:65–70
  6. Fried LP, Ferrucci L, Darer J, Williamson JD, Anderson G. Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J Gerontol A Biol Sci Med Sci. 2004;59:255–263
  7. Canadian Institute for Health Information Partnership for Health Informations Standards . WHIC Chronic Disease Management Infostructure. CDM data standards. Fall 2005;Symposium http://secure.cihi.ca/cihiweb/en/downloads/WHIC_CDM_Management_Infostructure_CDM_Data_Standards_Peter_Sargious.pdf
  8. John R, Kerby DS, Hennessy CH. Patterns and impact of comorbidity and multimorbidity among community-resident American Indian elders. The Gerontologist. 2003;43:649–660
  9. van den Akker M, Buntinx F, Metsemakers JF, Roos S, Knottnerus JA. Multimorbidity in general practice: prevalence, incidence, and determinants of co-occurring chronic and recurrent diseases. J Clin Epidemiol. 1998;15:367–375
  10. Anderson G, Horvath J. Chronic conditions: making the case for ongoing care. Princeton, NJ: Robert Wood Johnson Foundation's Partnership for Solutions; 2002;
  11. Bierman AS, Clancy CM. Women's health, chronic disease, and disease management: new words and old music?. Womens Health Issues. 1999;9:2–17
  12. Guralnik JM, LaCroix A, Evertt D. Aging in the eighties: the prevalence of co-morbidity and its association with disability. Washington, DC: DHHS (NCHS); 1989;
  13. Verbrugge LM, Lepkowski JM, Imanaka Y. Comorbidity and its impact on disability. Milbank Q. 1989;67:450–484
  14. Shwartz M, Iezzoni LI, Moskowitz MA, Ash AS, Sawitz E. The importance of comorbidities in explaining differences in patient costs. Med Care. 1996;34:767–782
  15. Guralnik JM. Assessing the impact of comorbidity in the older population. Ann Epidemiol. 1996;6:376–380
  16. Verbrugge LM, Lepkowski JM, Konkol LL. Levels of disability among U.S. adults with arthritis. J Gerontol Soc Sci. 1991;46:S71–S83
  17. van den Akker M, Buntinx F, Roos S, Knottnerus JA. Problems in determining occurrence rates of multimorbidity. J Clin Epidemiol. 2001;54:675–679
  18. Harboun M, Ankri J. Indices de comorbidite: revue de la litterature et application aux etudes des populations agees. Rev Epidemiol Sante Publique. 2001;49:287–298
  19. De Groot V, Becjerman H, Lankhorst GJ, Bouter LM. How to measure comorbidity: a critical review of available methods. J Clin Epidemiol. 2003;56:221–228
  20. Abete P. Comorbidity in the elderly: epidemiology and clinical features. G Gerontol. 2004;52:267–272
  21. Evans T, Michael W, Marciniak J. Software quality assurance and management. New York, NY: John Wiley & Sons Inc; 1987;
  22. Wilson T, Holt T, Greenlagh T. Complexity and clinical care. Br Med J. 2001;323:685–688
  23. Kurtz C, Snowden D. The new dynamics of strategy: sense-making in a complex and complicated world. IBM Syst J. 2003;42:462–483
  24. Hoff T. The power of frontline workers in transforming organizations. The Upstate New York Veteran's Health Administration. IBM center for healthcare management. December 2003;Available at: http://www-1.ibm.com/services/us/bcs/pdf/ibm_healthcaremanagement_power_it.pdf
  25. Glouberman S, Zimmerman B. Complicated and complex systems: what would successful reform of Medicare look like?. Discussion paper No 8. commission on the future of health care in Canada. 2002;
  26. Crabtree BF, Miller WL, Stange KC. Understanding practice from the ground up. J Fam Pract. 2001;50:881–887
  27. Plsek PE, Greenlagh T. Complexity science: the challenge of complexity in health care. Br Med J. 2001;323:625–628
  28. Covinsky KE, Justice AC, Rosenthal GE, Palmer RM, Landefeld CS. Measuring prognosis and case mix in hospitalized elders. The importance of functional status. J Gen Intern Med. 1997;12:203–208
  29. Alarcon T, Barcena A, Gonzalez-Montalvo JI, Penalosa C, Salgado A. Factors predictive of outcome on admission to an acute geriatric ward. Age Ageing. 1999;28:429–432
  30. Bo M, Massaia M, Raspo S, Bosco F, Cena P, Molaschi M, et al. Predictive factors of in-hospital mortality in elder patients admitted to a medical intensive care unit. Am Geriatr Soc. 2003;51:529–533
  31. Rockwood K, Stadnyk K, Carver D, MacPherson KM, Beanlands HE, Powell C, et al. A clinimetric evaluation of specialized geriatric care for rural dwelling, frail older people. J Am Geriatr Soc. 2000;48:1080–1085
  32. Fisher AL. Just what defines frailty?. J Am Geriatr Soc. 2005;53:2229–2230
  33. Flugelman MY, Ben David Y, Harats N, Eliakim M. A simple prognostic index for hospitalized geriatric patients. Gerontology. 1986;32:272–630
  34. Jones DM, Song X, Rockwood K. Operationalizing a frailty index from a standardized comprehensive geriatric assessment. J Am Geriatr Soc. 2004;52:1929–1933
  35. Rockwood K, Silvius JL, Fox RA. Comprehensive geriatric assessment. Postgrad Med. 1998;12:189–198
  36. Mitnitski AB, Graham JE, Mogilner AJ, Rockwood K. Frailty, fitness and late-life mortality in relation to chronological and biological age. BMC Geriatr. 2002;2:1
  37. Mitnitski AB, Song X, Skoog I, Brae GA, Cox JL, Grunfeld E, et al. Relative fitness and frailty of elderly men and women in developed countries, in relation to mortality. J Am Geriatr Soc. 2005;53:2184–2189
  38. Gijsen R, Hoeymans N, Schellevis FG, Ruwaard D, Satariano WA, van den Bos GA. Causes and consequences of comorbidity: a review. J Clin Epidemiol. 2001;54:661–674
  39. Gray LK, Smyth KA, Palmer RM, Zhu X, Callahan JM. Heterogeneity in older people: examining physiologic failure, age and comorbidity. J Am Geriatr Soc. 2002;50:1955–1961
  40. Zhang JX, Rathouz PJ, Chin MH. Comorbidity and the concentration of healthcare expenditures in older patients with heart failure. J Am Geriatr Soc. 2003;51:476–482
  41. Perkins AJ, Kroenke K, Unutzer J, Katon W, Williams JW, Hope C, et al. Common comorbidity scales were similar in their ability to predict health care costs and mortality. J Clin Epidemiol. 2004;57:1040–1048
  42. Starfield B, Lemke KW, Bernhardt T, Foldes SS, Forrest CB, Weiner JP. Comorbidity: implications for the importance of primary care in ‘case’ management. Ann Fam Med. 2003;1:8–14
  43. Caplan GA, Williams AJ, Daly B, Abraham K. A randomized, controlled trial of comprehensive geriatric assessment and multidisciplinary intervention after discharge of elderly from the emergency department— the DEED II study. J Am Geriatr Soc. 2004;52:1417–1423
  44. Rubenstein LZ. An overview of comprehensive geriatric assessment: rationale, history, program models, basic components. In:  Rubenstein LZ,  Wieland D,  Bernabei R editor. Geriatric assessment technology. Milan: Kurtis; 1995;
  45. Rubenstein LZ, Josephson KR, Wieland GD, English PA, Sayre JA, et al. Effectiveness of a geriatric evaluation unit. A randomised clinical trial. N Engl J Med. 1984;311:1664–1670
  46. Stuck AE, Siu AL, Wieland GD, Adams J, Rubenstein LZ. Comprehensive geriatric assessment: a meta-analysis of controlled trials. Lancet. 1993;342:1032–1036
  47. Rubenstein LZ, Joseph T. Freeman award lecture: comprehensive geriatric assessment: from miracle to reality. J Gerontol A Biol Sci Med Sci. 2004;59A:473–477
  48. Senin U. La complessità clinica dell'anziano ospedalizzato. Firenze: 49° Congresso Nazionale SIGG; Novembre 4 2004;
  49. Beers, M.K.H., Jones, T.V., Berkwits, M. et al. The Merck Manual of Geriatrics, 3rd ed., 2000. http://www.merck.com/mrkshared/mmg/home.jsp.
  50. Elixhauser A, Steiner C, Harris DR, Coffey RM. Comorbidity measures for use with administrative data. Med Care. 1998;36:8–27
  51. Powell H, Lim LL, Heller RF. Accuracy of administrative data to assess comorbidity in patients with heart disease. An Australian perspective. J Clin Epidemiol. 2001;54:687–693
  52. Quan H, Parsons GA, Ghali WA. Validity of information on comorbidity derived from ICD-9-CM administrative data. Med Care. 2002;40:675–685
  53. Britt H, Miller G, Knox S, Charles J, Valenti L, Pan Y, et al. General practice activity in Australia 2003–04. Canberra: Australian Institute of Health and Welfare; 2004;(AIHW Cat. No. GEP-16) Available at http://www.aihw.gov.au/publications/index.cfm/title/10079
  54. Pilotto A, Greco A, Franceschi M, Siena F, Scarcelli C, Miscio L, et al. All patient refined drug: a new tool to evaluate costs in the elderly acute inpatients. G Gerontol. 2004;52:262–266
  55. Ouwens M, Wollersheim H, Hermens R, Hulscher M, Grol R. Integrated care programs for chronically ill patients: a review of systematic reviews. Int J Qual Health Care. 2005;17:141–146
  56. Rehman HU. Under-representation of the elderly in clinical trials. Eur J Int Med. 2005;16:385–386
  57. Boyd CM, Darer J, Boult C, Fried LP, Boult L, Wu AW. Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: implications for pay for performance. JAMA. 2005;294:716–724
  58. Editorial . When clinical practice guidelines fail. Lancet. 2005;365:1440
  59. Linee-Guida sull'Utilizzazione della Valutazione Multidimensionale per l'Anziano Fragile nella Rete dei Servizi, Progetto Finalizzato del Ministero della Sanità ICS 110.1 RF 98.98, 2001.
  60. Robertson RG, Montagnini M. Geriatric failure to thrive. Am Fam Physician. 2004;70:343–350
  61. Senin U. Frail elderly: a new clinical entity in the aging society. http://www.leadershipmedica.com/sommari/2005/numero_08/medicina/sessione_1/articolo_ing/interfaccia.htm2005;
  62. The Hong Kong Geriatrics Society. Will you still cure me, when I'm 75? HKGS's Response to the Discussion Paper, on “Building a Healthy Tomorrow— Discussion Paper on the Future Service Delivery Model for our Health Care System” (published by Health, Welfare and Food Bureau of the Hong Kong Special Administrative Region Government in July 2005).
  63. Rozman, C. Current and future status of internal medicine, 2005 Available at www.icim.intramed.net/english/documentos.htm.
  64. Smith, R. NHS conception of a model for managing patients with long term conditions, 2005. Available at http://bmj.bmjjournals.com/talks/big_clinical_and_research_issues/tsld032.htm.
  65. Kane RL. The chronic care paradox. J Aging Soc Policy. 2000;11:107–114
  66. Kane RL. Changing the face of long term care. J Aging Soc Policy. 2005;17:1–18
  67. Weiner M, Callahan CM, Tierney WM, Overhage JM, Mamlin B, Dexter PR, et al. Using information technology to improve the health care of older adults. Ann Intern Med. 2003;139:430–436
  68. Rockwood K, Hubbard R. Frailty and the geriatrician. Age Ageing. 2004;33:429–430
  69. Martin CM, Sturmberg JP. General practice— chaos, complexity and innovation. MJA. 2005;183:106–109
  70. Barabási A-L. Linked: how everything is connected to everything else and what it means for business, science and everyday life. New York: Plume; 2003;
  71. Hammerly . Commentary: patient-centered care, the sine qua non of collaborative medicine. Am J Med Qual. 2002;17:33–38
  72. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–383
  73. Roos LL, Stranc L, James RC, Li J. Complications, comorbidity and mortality: improving classification and prediction. Health Serv Res. 1997;32:229–238
  74. Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative database. J Clin Epidemiol. 1992;45:613–619
  75. Stukenborg GJ, Wagner DP, Connors AF. Comparison of the performance of two comorbidity measures, with and without information from prior hospitalizations. Med Care. 2001;39:727–739
  76. Sloan KL, Sales AE, Liu CF, Fishman P, Nichol P, Suzuki NT, et al. Construction and characteristics of the RxRisk-V: a VA-adapted pharmacy-based case-mix instrument. Med Care. 2003;41:761–774
  77. Quan H, Sundararajan V, Halfon P, Fong A, Burnand B, Luthi JC, et al. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care. 2005;43:1130–1139
  78. Greenfield S, Apolone G. Assessment of Comorbidity: the Index of Coexistent Disease (ICED). In: (Rating manual) New England Medical Center, Boston, MA. 1991;p. 22
  79. Greenfield S, Sullivan L, Dukes KA, Silliman R, D'Agostino R, Kaplan SH. Development and testing of a new measure of case mix for use in office practice. Med Care. 1995;33:AS47–AS55
  80. Rozzini R, Frisoni GB, Ferrucci L, Barbisoni P, Sabatini T, Ranieri P, et al. Geriatric Index of comorbidity: validation and comparison with other measures of comorbidity. Age Ageing. 2002;31:277–285
  81. Linn BS, Linn MW, Gurel L. Cumulative illness rating scale. J Am Geriatr Soc. 1968;16:622–626
  82. Kaplan MH, Feinstein AR. The importance of classifying initial co-morbidity in evaluating the outcome of diabetes mellitus. J Chronic Dis. 1974;27:387–404
  83. Piccirillo KF, Tierney RM, Costas I, Grove L, Spitznagel EL. Prognostic importance of comorbidity in a hospital-based cancer registry. JAMA. 2004;291:2441–2447
  84. Incalzi RA, Capparella O, Gemma A. The interaction between age and co morbidity contributes to predicting mortality of geriatric patients in acute-care hospital. J Intern Med. 1997;242:291–298

PII: S0953-6205(07)00101-X

doi: 10.1016/j.ejim.2007.05.002

European Journal of Internal Medicine
Volume 18, Issue 5 , Pages 359-368 , September 2007

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