{smcl}
{* October 25, 2010}
{* Version 3.0}
help for {hi:altcharl}
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{title:Title}

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{cmd:altcharl} -- Charlson Score & Comorbidities


{title:Version}

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Version 3.0.

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ICDPIC Version 3.0 requires STATA 8.0 or higher.  ICDPIC Version 3.0 has been tested in STATA 10 and STATA 11, but the authors believe it
should also work without incident in STATA 8 and STATA 9.  If you have any problems using ICDPIC Version 3.0 in STATA 8 or STATA 9, please
inform the authors.

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ICDPIC Version 3.0 may be installed from within STATA using the {bf:ssc} command.  If you installed a previous version of ICDPIC from the SSC
archives website using the {bf:ssc} command, we suggest that you first delete it by typing {bf:ssc uninstall icdpic} followed by
{bf:ssc install icdpic}.  Alternatively, you may use {bf:ssc install icdpic, replace}.  See help for {help ssc}.

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If you installed any previous ICDPIC files obtained directly from the authors, please delete them {bf:ALL} (.ado, .hlp and .dta files) to avoid
any conflicts with ICDPIC 3.0 files.

{p 4 4 2}
Please enter complete variable names in the ICDPIC Version 3.0 dialog boxes.  Do not use abbreviations.

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New to Version 3.0 is the addition of a dialog box (.dlg) file associated with each individual ICDPIC Version 3.0 program (.ado) file.  To access
the ICDPIC dialog box, and all the ICDPIC programs, type: {cmd:db icdpic}.  Typing {cmd:icdpic}, as in earlier versions, will still work, but
{bf:ONLY} with {bf:icdpic}.  For example, to access the Charlson Score\Comorbidities (Alternate Version) program directly, type: {bf:db altcharl}.
Typing {bf:altcharl}, as in previous versions, will produce an error.

{p 4 4 2}
Fixed in ICDPIC Version 3.0 is the ability to use path\file names containing spaces.

{p 4 4 2}
Fixed in ICDPIC Version 3.0 is the ability to run in STATA 11.0.

{p 4 4 2}
Fixed in ICDPIC Version 3.0 is a bug that caused the {bf:triss} program to crash if the {it:rts} variable was named anything other than "rts".

{p 4 4 2}
New in ICDPIC Version 3.0 ({bf:trauma} program only) is the ability to choose whether an AIS value of 6 automatically forces an ISS of
75 or to automatically have all AIS values of 6 changed to an AIS value of 5 and then have the ISS calculated normally.

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All dialog boxes in ICDPIC Version 3.0 have memory.  Each time a dialog box is opened within the same STATA session, it will remember the values
last entered.

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All dialog boxes in ICDPIC Version 3.0 have the following buttons:

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{it:OK} executes the program and removes the dialog box from the screen.

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{it:SUBMIT} executes the program and leaves the dialog box on the screen.  Note that if an error message is generated the dialog box may
be minimized.

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{it:CANCEL} removes the dialog box from the screen and does nothing.  Clicking on the close icon of the dialog box does the same thing.

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{it:HELP} leaves the dialog box on the screen and presents the program help file.  The {it:HELP} button has a question mark on it.

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{it:COPY} leaves the dialog box on the screen and copies the program command to the clipboard.

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{it:RESET} resets the values of the controls in the dialog box to their initial state, just as if the dialog box were invoked
for the first time.  Each time a user invokes a dialog box, its controls will be filled in with the values the user last entered.
{it:RESET} restores the control values to their defaults.  The {it:RESET} button has an R on it.


{title:Syntax}

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{cmd:db altcharl}

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The {it:Charlson Score & Comorbidities (Alt. Ver.)} dialog box will open.  Follow the instructions.  

{center:{bf:{it:OR}}}

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{cmd:db icdpic}

{p 4 4 2}
The {it:ICDPIC} dialog box will open.  Choose {it:Charlson Score\Comorbidities (Alternate Version)} and click
{it:OK} or {it:Submit}.  The {it:Charlson Score & Comorbidities (Alt. Ver.)} dialog box will open.  Follow the instructions.  


{title:Description}

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{cmd:altcharl} determines which Charlson comorbidities are present, the number of Charlson comorbidities present and the
Charlson score.


{center:CHARLSON SCORE = the sum of the weights of each comorbidity present}


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If mild liver disease and moderate to severe liver disease are both present, only the presence of moderate to severe liver
disease is used in calculating the Charlson score.  If both mild to moderate diabetes mellitus and diabetes mellitus,
chronic complications, are both present, only the presence of diabetes mellitus, chronic complications, is used in
calculating the Charlson score.  If any malignancy and metastatic solid tumor are both present, only the presence of
metastatic solid tumor is used in calculating the Charlson score.  The above also pertains in determining which 
comorbidities are present and calculating the number of comorbidities.  For example, if both mild and moderate to severe
liver disease are present only the moderate to severe liver disease variable indicates the presence of a comorbidity and is
counted in determining both the number of comorbidities and the Charlson score.

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Comorbidity diagnostic categories are included if, and only if, they include ICD-9-CM codes identified by
Romano et al, with an asterisk under the column "Dartmouth-Manitoba codes" in Table 1 of that study.  Within these included
categories, only diagnosis or procedure codes with asterisks are used.  Exceptions are Rheumatologic Disease and AIDS
categories, which were too rare to be included in the original study but have been included in our version.

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A complete list of all categories, diagnosis codes and procedure codes used to calculate our version of the Charlson Score
is given below.  
            
                                                                                          
    {bf:Comorbidity}                     {bf:ICD-9-CM Diagnosis Code*}        {bf:ICD-9-CM Procedure Code*}

    Myocardial Infarction           412

    Peripheral Vascular             440.X, 441.X, 442.X,            39.22-39.26, 39.29,
    Disease                         443.1-443.9, 447.1,             38.13, 38.14, 38.16,
                                    785.4                           38.18, 38.33, 38.34,
                                                                    38.36, 38.38, 38.43,
                                                                    38.44, 38.46, 38.48 
                                                 
    Dementia                        290-290.9, 331-331.2

    Chronic Obstructive             415.0, 416.8-416.9,
    Pulmonary Disease               491.X-494, 496
       
    Rheumatologic Disease           710.X, 714.X

    Mild Liver Disease              571.2, 571.5-571.6,
                                    571.8-571.9

    Moderate to Severe              572.2-572.4,                     39.1, 42.91
    Liver Disease                   456.0-456.2X

    Mild to Moderate                250.0X-250.3X
    Diabetes Mellitus

    Diabetes Mellitus,              250.4X-250.9X
    Chronic Complications

    Renal Disease                   585-586, V42.0, V45.1,           39.27, 39.42, 
                                    V56.X, V56.8                     39.93-39.95, 54.98

    Any Malignancy                  140.X-171.X,                     60.5, 62.4-62.41**
                                    174.X-195.X,
                                    200.X-208.X, 273.0,
                                    273.3, V10.46

    Metastatic Solid Tumor          196.X-199.X

    AIDS                            042-044.9**


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*NOTE1: Diagnosis and procedure code reference tables have been updated to reflect new codes within the above specified
ranges.  No attempt has been made to identify and include individual codes that may be applicable.

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**NOTE2: Diagnosis codes 43.X and 44.X are no longer valid and are not included in the diagnosis code reference table.
Procedure code 62.4 seems to have always been a sub category rather than an actual procedure code but has been left in as
it will not cause any harm.


    CATEGORIES EXCLUDED:

        Congestive Heart Failure
        Cerebrovascular Disease
        Peptic Ulcer Disease
        Hemiplegia or Paraplegia


    VARIABLES ADDED TO THE USER'S DATA:

        Boolean variables for each comorbidity category: 0 if absent; 1 if present
        A variable to count the number of comorbidities present
        A variable for the Charlson score


    WEIGHTED COMORBIDITIES AS SUGGESTED BY CHARLSON:

        Myocardial Infarction = 1
        Peripheral Vascular Disease = 1
        Dementia = 1
        Chronic Obstructive Pulmonary Disease = 1
        Rheumatologic Disease = 1
        Mild Liver Disease = 1
        Mild to Moderate Diabetes Mellitus = 1
        Renal Disease = 2
        Diabetes Mellitus, Chronic Complications = 2
        Any Malignancy = 2
        Moderate to Severe Liver Disease = 3
        Metastatic Solid Tumor = 6
        AIDS = 6

               
{p 4 4 2}
For a more standardized treatment of the Charlson comorbidity index, with options that include ICD-9-CM, ICD-10-CM and
enhanced ICD-9-CM versions, the user is encouraged to type "findit charlson" from within STATA without the quotation marks.
STATA will locate this module on the Internet.  Just follow the instructions given to download it.

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See also the {bf:Options} and {bf:Remarks} sections for {bf:IMPORTANT} information on, and requirements for, {cmd:altcharl}.
 

{title:Options}

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ICD-9-CM diagnosis and procdure codes in the user's data may, or may not, contain a decimal point.  Simply choose the
option that applies to your data in the {it:Charlson Score & Comorbidities (Alt. Ver.)} dialog box. 


{title:Remarks}

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{cmd:altcharl} adds the following Boolean variables (0 if absent, 1 if present) to a new copy of the user's data stored
on disk:


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{it:mi}: myocardial infarction {p_end}
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{it:pvd}: peripheral vascular disease {p_end}
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{it:dementia}: dementia {p_end}
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{it:copd}: chronic obstructive pulmonary disease {p_end}
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{it:rheum}: rheumotologic disease {p_end}
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{it:mld}: mild liver disease {p_end}
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{it:sld}: moderate to severe liver disease {p_end}
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{it:mdm}: moderate diabetes mellitus {p_end}
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{it:ccdm}: chronic complications of diabetes mellitus {p_end}
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{it:renal}: renal disease {p_end}
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{it:any_mal}: any malignancy {p_end}
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{it:mst}: metastatic solid tumor {p_end}
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{it:aids}: AIDS {p_end}


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{cmd:altcharl} also adds the following variables to a new copy of the user's data stored on disk:


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{it:charlcnt}: the total number of comorbidities present {p_end}
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{it:charlval}: the Charlson score {p_end}


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The user's data must contain both ICD-9-CM diagnosis codes and ICD-9-CM procedure codes.  ICD-9-CM codes in the user's
data must be of type string.  A decimal point in the ICD-9-CM codes is optional.  Diagnosis codes should have a width of
5 (6 if a decimal point is present) and procedure codes should have a with of 4 (5 if a decimal point is present).  The
diagnosis code prefix must be the same for all diagnosis codes and numbered sequentially starting with 1, for example,
dx1...dxN.  The same holds true for procedure codes, for example, px1...pxN.

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{cmd:altcharl} requires the use of lookup tables {bf:cdtab_s1.dta}, {bf:cdtab_s2.dta}, {bf:cptab_s1.dta} and
{bf:cptab_2.dta}.  These data tables are supplied.  _s1 tables are for use with data without the decimal point in ICD-9-CM
codes and _s2 tables are for data that include the decimal point.  See help for {help icdpic}, specifically the LOOKUP
TABLES part of the {bf:Remarks} section. 
 

{title:Examples}

None


{title:Authors}

{p 4}
David E. Clark, M.D.

{p 8 12 2}
Maine Medical Center, Portland, Maine, USA {p_end}
{p 8 12 2}
University of Vermont College of Medicine, Burlington, Vermont, USA {p_end}
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Harvard Injury Control Research Center, Harvard School of Public Health, Boston, Massachusetts, USA {p_end}

{p 8}
Correspondence to Dr. Clark, {p_end}
{p 8}
887 Congress Street, Portland ME 04102 {p_end}
{p 8} 
Email:  clarkd@mmc.org {p_end}

{p 4}
Turner M. Osler, M.D.

{p 8 12 2}
University of Vermont College of Medicine, Burlington, Vermont, USA {p_end}

{p 4}
David R. Hahn

{p 8 12 2}
Maine Medical Center, Portland, Maine, USA {p_end}


{title:References}

{p 4 4 2}
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies:
Development and validation.  {it:J Chronic Dis} 1987;40:373-383.

{p 4 8 2}
Romano PS, Roos LL, Jollis JG. Adapting a clinical comorbidity index for use with ICD-9-CM administrative data:
Differing perspectives.  {it:J Clin Epidemiol} 1993;46:1075-1079.


{title:Also see}

{p 4}
help for {help icdpic}

{p 4}
help for {help altcharl}





