Model-based Prediction of Length of Stay for Rehabilitating Stroke Patients
Model-based Prediction of Length of Stay for Rehabilitating Stroke Patients
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DOI：
10.1016/s0929-6646(09)60386-7
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发表时间：
2009-08-01
影响因子：
3.2
通讯作者：
Wu, Hong-Dar Isaac
中科院分区：
文献类型：
--
作者：
Lin, Chien-Lin;Lin, Pao-Hsuan;Wu, Hong-Dar Isaac
背景/目的：准确的住院时间（LOS）估计对卒中患者的医疗费用有影响。大多数研究只报告了描述性的样本平均值或提供了基于线性模型的估计服务水平。本研究通过将出院作为一个事件处理，并利用比例风险（PH）模型来计算点和区间估计，以提供对首次卒中患者在康复科的临床center.Methods：年龄，性别，合并症状态，改良Barthel指数（MBI）和功能独立性测量（FunctionalIndependentMeasure，FIELD）之间的相关性进行成对分析。这些解释变量用于K样本比较、关联性卡方检验、PH回归分析和对数转换线性（LTL）回归。PH模型对估计的平均LOS进行了预测，通过将MBI和ESTA合并为单个变量，绝对偏差为0.85天，或者MBI和ESTA变量的偏差为1.15天和1.16天，基于LTL的估计产生了5.91天的偏差。PH模型具有相对较短的置信区间比样本平均值和LTL的methods.Conclusion：我们建议使用PH模型预测平均LOS时，PH假设为不同的临床特征的患者是满意的。然而，所提出的方法仅适用于中风患者的康复。[J Formos Med Assumption 2009;108（8）：653-662]
Background/Purpose: Accurate length-of-stay (LOS) estimates have an impact on medical costs for stroke patients. Most studies have reported only descriptive sample means or have provided linear-model-based estimates for LOS. This study calculated point and interval estimates by treating hospital discharge as an event, and utilizing the proportional hazards(PH) model to provide the estimation of hospital stay for first-ever stroke patients in a rehabilitation department of a clinical center.Methods: Pairwise analysis for correlations between age, sex, comorbidity status, modified Barthel index (MBI) and functional independence measure (FIM) was performed. These explanatory variables are used in the K-sample comparisons, the chi(2) test for association, the PH regression analysis, and log-transformed linear (LTL) regression.Results: The PH model gave a prediction on estimated mean LOS, with an absolute bias of 0.85 days, by combining MBI and FIM into a single variable, or a bias of 1.15 days and 1.16 days with MBI and FIM variables, respectively The LTL-based estimation generated a bias of 5.91 days. The PH model has relatively shorter confidence intervals than those obtained by sample-mean and LTL methods.Conclusion: We recommend using the PH model for predicting mean LOS when the PH assumption for patients with different clinical characteristics is satisfied. However, the proposed method only applies to rehabilitating stroke patients. [J Formos Med Assoc 2009;108(8):653-662]