Association of Patient-Centered Outcomes With Patient-Reported and ICD-9–Based Morbidity Measures

Article Figures & Data

Table 1

Participant Characteristics (N = 961)

Characteristic	n	%
Female	530	55.2
White race	787	81.9
Low socioeconomic status	129	13.4
Depressive symptoms (PHQ-9 >4)^a	342	35.6
Anxiety symptoms (GAD-7 >4)^a	201	20.9
Any inpatient admission^a	209	21.8
Any emergency department visit^b	222	23.1
Death within 10 months of survey	24	2.5

		Mean No. (SD)	Median (5%, 95%)

Age at survey, y	961	75.6 (5.7)	75 (68, 86)
Years enrolled before survey	961	12.4 (4.4)	14 (4, 17)
Self-reported disease count	961	7.9 (2.7)	8 (4, 12.5)
Self-reported disease burden score	960	16.8 (10.0)	15 (5, 36)
CCI year before survey	961	1.9 (1.9)	1 (0, 6)
Inclusion conditions^c	961	3.6 (0.8)	3 (3, 5)
Outcomes
General health score^d	961	58.9 (21.4)	62 (20, 87)
Physical component scale^d	958	36.4 (11.4)	36 (19, 54)
Mental component scale^d	958	54.8 (9.0)	57 (37, 66)
Financial constraints score^d	958	77.7 (26.2)	92 (25, 100)
Overwhelmed score^d	959	78.5 (22.4)	83 (33, 100)
General self-efficacy score^d	959	80.7 (16.2)	81 (50, 100)
Inpatient admissions^b (range = 0–7)	961	0.32 (0.72)	0 (0, 2)
Emergency department visits^b (range=0–14)	961	0.34 (0.80)	0 (0, 2)
Office visits^b (range = 0–62)	961	6.20 (4.97)	5 (3, 16)

CCI = Charlson comorbidity index; PHQ-9 = 9-item Patient Health Questionnaire; GAD-7 = Generalized Anxiety Disorder 7-item scale.
a Score of >4 indicative of symptoms of each condition.
↵b During the 10 months after the survey.
↵c From original inclusion criteria for cohort of having 3 or more of a list of 10 chronic conditions.
↵d Scored on a range from 1 to 100; higher scores indicate better outcomes (eg, better health, fewer financial constraints, greater self-efficacy).

Table 2

Summary of Significant Associations Between Morbidity Measures and Patient-Reported Outcomes

	Patient-Reported Outcomes^a

Morbidity Measure	General Health Status β (CI)^b	Physical Well-being β (CI)^b	Emotional Well-being β (CI)^b	Fewer Financial Constraints Odds Ratio (CI)^c	Less Overwhelmed Odds Ratio (CI)^c	Self-efficacy Odds Ratio (CI)^c
Quan adaptation of CCI (ICD-9)¹⁵ (range=0–12)	−1.91 (−2.50 to −1.33)^d	−0.68 (−0.99 to −0.37^d	0.06 (−0.19 to 0.31)	0.82 (0.73 to 0.91)^d	0.87 (0.78 to 0.96)^e	0.96 (0.86 to 1.08)
Self-reported disease burden²⁶ (range=1–89)	−0.71 (−0.84 to −0.59)^d	−0.49 (−0.56 to −0.42)^d	−0.11 (−0.16 to −.05)^d	0.96 (0.94 to 0.99)^f	0.95 (0.93 to 0.97)^d	0.96 (0.94 to 0.99)^f
Anxiety symptoms (GAD-7)³⁹ (range=0–21)	−2.75 (−5.88 to 0.37)	1.41 (−0.24 to 3.06)	−5.90 (−7.25 to −4.56)^d	0.64 (0.37 to 1.09)	0.57 (0.35 to 0.93)^e	0.79 (0.48 to 1.31)
Depressive symptoms (PHQ-9)³⁸ (range=0–27)	−12.01 (−14.75 to −9.27)^d	−4.99 (−6.44 to −3.54)^d	−5.87 (−7.05 to −4.69)^d	0.66 (0.39 to 1.13)	0.30 (0.18 to 0.50)^d	0.18 (0.10 to 0.33)^d

CCI = Charlson comorbidity index; GAD-7 = Generalized Anxiety Disorder 7-item scale; ICD- 9=International Classification of Disease, 9th edition; PHQ-9=9-item Patient Health Questionnaire.
Note: Associations expressed as point estimates with confidence intervals within separate models for each outcome.
↵a For all outcomes, higher outcome values represent a better state (eg, better physical functioning, fewer financial constraints). All models adjusted for morbidity measures above and age, sex, race, socioeconomic status, and length of enrollment.
↵b Linear regression: β estimates; nonsignificant confidence intervals cross zero.
↵c Logistic regression: odds ratios; nonsignificant confidence intervals cross 1.0.
↵d P value <.001.
↵e P value <.05.
↵f P value <.01.

Table 3

Summary of Significant Associations Between Morbidity Measures and Utilization Outcomes

	Utilization Outcomes^a

Morbidity Measure	Outpatient Utilization Negative Binomial Regression Rate Ratio (CI)^b	Inpatient Admission Logistic Regression Odds Ratio (CI)^c	Emergency Department Admission Logistic Regression Odds Ratio (CI)^c
Quan adaptation of CCI (ICD-9)¹⁵ (range=0–12)	1.05 (1.02–1.09)^d	1.17 (1.08–1.26)^d	1.12 (1.04–1.22)^d
Self-reported disease burden²⁶ (range=1–89)	1.02 (1.01–1.02)^e	1.03 (1.01–1.04)^d	1.01 (0.99–1.03)^f
Anxiety symptoms (GAD-7)³⁹ (range=0–21)	1.23 (1.03–1.47)^f	1.01 (0.65–1.58)	0.94 (0.62–1.43)
Depressive symptoms (PHQ-9)³⁸ (range=0–27)	1.00 (0.86–1.16)	0.81 (0.55–1.20)	1.72 (1.19–2.49)^d

CCI = Charlson comorbidity index; GAD-7 = Generalized Anxiety Disorder 7-item scale; ICD-9=International Classification of Diseases, Ninth Edition; PHQ-9=9-item Patient Health Questionnaire.
Note: Associations expressed as rate or odds ratios with confidence intervals within separate models for each outcome.
↵a All models adjusted for other morbidity measures and age, sex, race, socioeconomic status, follow-up time, and length of enrollment.
↵b Negative binomial regression; nonsignificant confidence intervals cross 1.0.
↵c Logistic regression; nonsignificant confidence intervals cross 1.0.
↵d P value <.01.
↵e P value <.001.
↵f P value <.05.