Development and Validation of the Nursing Home Minimum Data Set 3.0 Mortality Risk Score (MRS3)
Development and Validation of the Nursing Home Minimum Data Set 3.0 Mortality Risk Score (MRS3)
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DOI：
10.1093/gerona/gly044
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发表时间：
2019-02-01
影响因子：
5.1
通讯作者：
Mor, Vincent
中科院分区：
文献类型：
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作者：
Thomas, Kali S.;Ogarek, Jessica A.;Mor, Vincent
使用最小数据集3.0开发一个评分来预测死亡率（MDS 3.0），可以很容易地计算出从项目收集在疗养院（NH）居民的入院评估。参与者我们开发了一个培训队列的医疗保险受益人新承认美国NH在2012年（N = 1，426，815）和2013年的测试队列（N = 1，160，964）。方法数据来自与Medicare Beneficiary Summary File相关的MDS 3.0评估。使用训练数据集，我们开发了一个复合MDS 3.0死亡风险评分（MRS 3），包括17个临床项目和患者的年龄组，基于它们与30天死亡率的关系。我们评估的校准和歧视的MRS 3预测30和60天的死亡率，并比较其性能的Charlson合并症指数和临床医生的评估，6个月的预后测量admission.Results的30和60天的死亡率为测试人群分别为2.8%和5.6%，分别。逻辑回归模型的结果表明，MRS 3在预测30天和60天内的死亡方面表现良好（C-统计量分别为0.744 [95%置信限（CL）= 0.741，0.747]和0.709 [95% CL = 0.706，0.711]）。与Charlson合并症指数相比，MRS 3是死亡率的上级预测因子（C-统计量为0.611 [95% CL = 0.607，0.615]和0.608 [95% CL = 0.605，0.610]）和临床医生对患者6个月随访的评估结论MRS 3是一个很好的预测死亡率的指标，可用于指导决策、制定护理计划和调整患者的死亡风险。
Background To develop a score to predict mortality using the Minimum Data Set 3.0 (MDS 3.0) that can be readily calculated from items collected during nursing home (NH) residents' admission assessments.Participants We developed a training cohort of Medicare beneficiaries newly admitted to United States NHs during 2012 (N = 1,426,815) and a testing cohort from 2013 (N = 1,160,964).Methods Data came from the MDS 3.0 assessments linked to the Medicare Beneficiary Summary File. Using the training dataset, we developed a composite MDS 3.0 Mortality Risk Score (MRS3) consisting of 17 clinical items and patients' age groups based on their relation to 30-day mortality. We assessed the calibration and discrimination of the MRS3 in predicting 30- and 60-day mortality and compared its performance to the Charlson Comorbidity Index and the clinician's assessment of 6-month prognosis measured at admission.Results The 30- and 60-day mortality rates for the testing population were 2.8% and 5.6%, respectively. Results from logistic regression models suggest that the MRS3 performed well in predicting death within 30 and 60 days (C-Statistics of 0.744 [95% confidence limit (CL) = 0.741, 0.747] and 0.709 [95% CL = 0.706, 0.711], respectively). The MRS3 was a superior predictor of mortality compared to the Charlson Comorbidity Index (C-statistics of 0.611 [95% CL = 0.607, 0.615] and 0.608 [95% CL = 0.605, 0.610]) and the clinicians' assessments of patients' 6-month prognoses (C-statistics of 0.543 [95% CL = 0.542, 0.545] and 0.528 [95% CL = 0.527, 0.529]).Conclusions The MRS3 is a good predictor of mortality and can be useful in guiding decision-making, informing plans of care, and adjusting for patients' risk of mortality.