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. 2011 Oct;49(10):940-7.
doi: 10.1097/MLR.0b013e318229360e.

The mortality risk score and the ADG score: two points-based scoring systems for the Johns Hopkins aggregated diagnosis groups to predict mortality in a general adult population cohort in Ontario, Canada

Peter C Austin  1 , Carl van Walraven
Affiliations

The mortality risk score and the ADG score: two points-based scoring systems for the Johns Hopkins aggregated diagnosis groups to predict mortality in a general adult population cohort in Ontario, Canada

Peter C Austin et al. Med Care. 2011 Oct.

Abstract

Background: Logistic regression models that incorporated age, sex, and indicator variables for the Johns Hopkins' Aggregated Diagnosis Groups (ADGs) categories have been shown to accurately predict all-cause mortality in adults.

Objectives: To develop 2 different point-scoring systems using the ADGs. The Mortality Risk Score (MRS) collapses age, sex, and the ADGs to a single summary score that predicts the annual risk of all-cause death in adults. The ADG Score derives weights for the individual ADG diagnosis groups.

Research design: : Retrospective cohort constructed using population-based administrative data.

Participants: All 10,498,413 residents of Ontario, Canada, between the age of 20 and 100 years who were alive on their birthday in 2007, participated in this study. Participants were randomly divided into derivation and validation samples.

Measures: : Death within 1 year.

Results: In the derivation cohort, the MRS ranged from -21 to 139 (median value 29, IQR 17 to 44). In the validation group, a logistic regression model with the MRS as the sole predictor significantly predicted the risk of 1-year mortality with a c-statistic of 0.917. A regression model with age, sex, and the ADG Score has similar performance. Both methods accurately predicted the risk of 1-year mortality across the 20 vigintiles of risk.

Conclusions: The MRS combined values for a person's age, sex, and the John Hopkins ADGs to accurately predict 1-year mortality in adults. The ADG Score is a weighted score representing the presence or absence of the 32 ADG diagnosis groups. These scores will facilitate health services researchers conducting risk adjustment using administrative health care databases.

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Figures

Figure 1
Figure 1
Distribution of risk scores in derivation sample
Figure 2
Figure 2
Calibration plot: observed vs. predicted mortality
Figure 3
Figure 3
Calibration plot: observed vs. predicted mortality
See this image and copyright information in PMC

References

    1. Weiner Jonathan P., Editor in Chief, editor. The Johns Hopkins University Bloomberg School of Public Health, Health Services Research & Development Center. The Johns Hopkins ACG® Case-Mix System Version 6.0 Release Notes. The Johns Hopkins University; Apr, 2003.
    1. Johns Hopkins University. [accessed July 29, 2010];Johns Hopkins ACG Case-Mix Adjustment System. Available at: http://www.acg.jhsph.edu. Site.
    1. Weiner J, Starfield B, Steinwachs D, Abramson J. Development and application of a population-oriented measure of ambulatory care case-mix. Medical Care. 1991;29:452–472. - PubMed
    1. Starfield B, Weiner J, Murla P. Ambulatory care groups: A categorization of diagnoses for research and management. Health Services Research. 1991;26:53–74. - PMC - PubMed
    1. Using the Johns Hopkins Aggregated Diagnosis Groups (ADGs) to predict mortality in a general adult population cohort in Ontario, Canada. Medical Care. In-press. **** - PMC - PubMed

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