condensed the ECIs of 21 conditions into a single numeric score, known as the Van Walraven (VW) score. The ECI is based on the International Classification of Diseases, 9th and 10th Edition codes (ICD-9, ICD-10) and the Medicare Severity Diagnosis Related Groups (MS-DRGs) found in hospital administrative data. The ECI includes 31 conditions, and it was originally developed to predict in-hospital mortality, hospital charges, and length of stay. Patient comorbidities are generally quantified by using diagnosis-based indices or scores, such as the Elixhauser Comorbidity Index (ECI) and Charlson Comorbidity Index (CCI). Time-based comorbidity network identification could potentially allow for interruption of these networks at key times and improve clinical outcomes by altering the trajectory of disease. To determine the trajectory of a medical condition, it is important to identify time-related disease associations in population-based studies to define the temporal relationship of comorbidity development. Those that develop more comorbidities over time have worse health outcomes, and the rise in comorbidities is an important predictor of high-risk events. Two-thirds of Medicare spending is devoted to medically complex patients with four or more chronic conditions, with costs increasing exponentially as the number of comorbidities increases. Comorbidities impact the quality of life of patients and are often associated with increased rates of functional decline and mortality. When providing care for such patients for the primary condition, a balanced treatment plan that includes comorbidity management should be devised.
Treating and managing comorbidities is challenging because one comorbidity may exacerbate another, thereby increasing care complexity. The term comorbidity is defined as a pre-existing medical condition unrelated to the primary reason for a patient’s hospitalization, ideally excluding complications acquired during the hospital stay or later treatment. The management of medically complex individuals, those with multiple coexisting diseases known as comorbidities, is vital to the United States healthcare system due to the significant impact of comorbidities on health outcomes, clinical management, and increased healthcare costs.
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