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Cited by 30Chronic Disease Management StrategiesPharmaceutical Practices and Patient OutcomesFrailty in Older Adults

When Comorbidity, Aging, and Complexity of Primary Care Meet: Development and Validation of the Geriatric CompleXity of Care Index

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Min, Lillian, Wenger, Neil, Walling, Anne M., Blaum, Caroline, Cigolle, Christine, Ganz, David A., Reuben, David, Shekelle, Paul +2 more·2013·Journal of the American Geriatrics Society
DOI 10.1111/jgs.12160PMC PMC3698956
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Abstract

OBJECTIVES: To develop and validate the Geriatric CompleXity of Care Index (GXI), a comorbidity index of medical, geriatric, and psychosocial conditions that addresses disease severity and intensity of ambulatory care for older adults with chronic conditions. DESIGN: DEVELOPMENT phase: variable selection and rating by clinician panel. VALIDATION phase: medical record review and secondary data analysis. SETTING: Assessing the Care of Vulnerable Elders-2 study. PARTICIPANTS: Six hundred forty-four older (≥75) individuals receiving ambulatory care. DEVELOPMENT: 32 conditions categorized according to severity, resulting in 117 GXI variables. A panel of clinicians rated each GXI variable with respect to the added difficulty of providing primary care for an individual with that condition. VALIDATION: Modified versions of previously validated comorbidity measures (simple count, Charlson, Medicare Hierarchical Condition Category), longitudinal clinical outcomes (functional decline, survival), intensity of ambulatory care (primary, specialty care visits, polypharmacy, number of eligible quality indicators (NQI)) over 1 year of care. RESULTS: The most-morbid individuals (according to quintiles of GXI) had more visits (7.0 vs 3.7 primary care, 6.2 vs 2.4 specialist), polypharmacy (14.3% vs 0% had ≥14 medications), and greater NQI (33 vs 25) than the least-morbid individuals. Of the four comorbidity measures, the GXI was the strongest predictor of primary care visits, polypharmacy, and NQI (P < .001, controlling for age, sex, function-based vulnerability). CONCLUSION: Older adults with complex care needs, as measured by the GXI, have healthcare needs above what previously employed comorbidity measures captured. Healthcare systems could use the GXI to identify the most complex elderly adults and appropriately reimburse primary providers caring for older adults with the most complex care needs for providing additional visits and coordination of care.

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  • Machine learning classifiers trained on heterogeneous datasets may average out critical features associated with specific subtypes, thereby reducing both model accuracy and clinical utility.

    “For instance, machine learning classifiers trained on heterogeneous datasets may average out critical features associated with specific subtypes, thereby reducing both model accuracy and clinical utility420.”

    From Artificial intelligence-driven multi-omics approaches in Alzheimer's disease: Progress, challenges, and future directions (2025) · cites this paper as [420]

    The Results section shows that a simple condition count failed to distinguish two patients with different care complexity, and the Discussion compares how comorbidity indices predict different outcomes. Neither passage addresses machine-learning classifiers trained on heterogeneous datasets, subtype-specific features being averaged out, or the claimed effect on model accuracy and clinical utility. Searches for those terms and their paraphrases found no supporting passage in our copy; page numbers were unavailable. (LLM, conf=0.76)

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Authors
Min, L., Wenger, N., Walling, A. M., Blaum, C., Cigolle, C., Ganz, D. A., Reuben, D., Shekelle, P., Roth, C., & Kerr, E. A.
Affiliations
  • University of Michigan (US)
  • RAND Corporation (US)
  • NYU Langone Health (US)
  • University of California, Los Angeles (US)
Corresponding author
Min, Lillian
ORCID
Venue
Journal of the American Geriatrics Society
Publisher
Wiley
Published
2013-03-21
Volume
61
Issue
4
Pages
542-550
ISSN
  • 0002-8614 (ISSN-L)
  • 1532-5415
DOI
10.1111/jgs.12160
PMC
PMC3698956
OpenAlex
W2034050494
Cited by
30
References
4
Citations by year
2026: 1 · 2025: 2 · 2024: 1 · 2023: 3 · 2020: 2 · 2019: 5 · 2018: 1 · 2017: 3 · 2016: 1 · 2015: 3 · 2014: 8
FWCI
2.92
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Journal of the American Geriatrics Society (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • Deep Blue (University of Michigan) (submittedVersion)
Funders
  • National Institutes of Health (5k08ag031837-05)
  • Agency for Healthcare Research and Quality (R21HS017621)
  • National Institute on Aging (K08-AG-031837, P30AG024824)
  • National Institute of Diabetes and Digestive and Kidney Diseases (P30DK092926)
Topics
  • Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
  • Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
  • Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
Keywords
comorbidity index, older adults, chronic disease, primary care, polypharmacy, functional decline, quality indicators, health care needs assessment, elderly care, care coordination
MeSH terms
Aged, Aged, 80 and over, Aging, Chronic Disease, Female, Health Services for the Aged, Health Services Research, Health Status Indicators, Humans, Male, Primary Health Care, Quality Assurance, Health Care, Severity of Illness Index, Geriatric Assessment, Comorbidity

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