Veterans Affairs patient database (VAPD 2014-2017): building nationwide granular data for clinical discovery
Veterans Affairs patient database (VAPD 2014-2017): building nationwide granular data for clinical discovery
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DOI：
10.1186/s12874-019-0740-x
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发表时间：
2019-05-08
影响因子：
4
通讯作者：
Iwashyna, Theodore J.
中科院分区：
文献类型：
--
作者：
Wang, Xiao Qing;Vincent, Brenda M.;Iwashyna, Theodore J.
为了研究急性住院期间的患者生理学，我们试图在单个患者-设施-天的水平上创建可访问的、标准化的全国数据。本文总结了2014-2017年退伍军人事务患者数据库（VAPD 2014-2017）的开发，组织和特征。VAPD 2014-2017包含来自全国VA医疗保健系统所有部分的急性住院治疗，包括日常生理学，包括临床数据（实验室，生命体征，药物，风险评分等），重症监护病房（ICU）指标，设施，病人，和住院characteristics.MethodsThe VA数据结构和数据库组织代表了一个复杂的多医院系统。我们将单中心住院定义为在单一机构接受急性治疗专科的一次或多次连续住院。VAPD 2014-2017是在患者-设施-日级别上构建的，其中医院中的每个患者-日都是一行，具有针对设施、患者和住院的单独标识变量。VAPD 2014-2017包括日常实验室检查、生命体征和住院药物。这些数据通过实验室值范围和与患者图表的比较进行了确认和验证。脓毒症，风险评分和器官功能障碍的定义进行了标准化和calculated.ResultsWe确定了565，242单站点住院（SSHS）在2014年; 558，060 SSHS在2015年; 553，961 SSHS在2016年;和550，236 SSHS在2017年在141 VA医院。所有研究年份的平均住院时间为4天。住院死亡率从2014年到2017年下降（1.7%到1.4%），30天再入院率从2014年的15.3%上升到2017年的15.6%; 30天死亡率也从2014年的4.4%下降到2017年的4.1%。从2014年到2017年，有107，512（4.8%）的SSHS符合疾病控制和预防中心的基于电子健康记录的回顾性定义sepsis.ConclusionThe VAPD 2014-2017代表了一个大型的，标准化的收集粒度数据从一个异构的全国性医疗保健系统。它也是研究急性和危重病期间住院患者生理学演变的直接资源。
BackgroundTo study patient physiology throughout a period of acute hospitalization, we sought to create accessible, standardized nationwide data at the level of the individual patient-facility-day. This methodology paper summarizes the development, organization, and characteristics of the Veterans Affairs Patient Database 2014-2017 (VAPD 2014-2017). The VAPD 2014-2017 contains acute hospitalizations from all parts of the nationwide VA healthcare system with daily physiology including clinical data (labs, vitals, medications, risk scores, etc.), intensive care unit (ICU) indicators, facility, patient, and hospitalization characteristics.MethodsThe VA data structure and database organization represents a complex multi-hospital system. We define a single-site hospitalization as one or more consecutive stays with an acute treating specialty at a single facility. The VAPD 2014-2017 is structured at the patient-facility-day level, where every patient-day in a hospital is a row with separate identification variables for facility, patient, and hospitalization. The VAPD 2014-2017 includes daily laboratory, vital signs, and inpatient medication. Such data were validated and verified through lab value range and comparison with patient charts. Sepsis, risk scores, and organ dysfunction definitions were standardized and calculated.ResultsWe identified 565,242 single-site hospitalizations (SSHs) in 2014; 558,060 SSHs in 2015; 553,961 SSHs in 2016; and 550,236 SSHs in 2017 at 141 VA hospitals. The average length of stay was four days for all study years. In-hospital mortality decreased from 2014 to 2017 (1.7 to 1.4%), 30-day readmission rates increased from 15.3% in 2014 to 15.6% in 2017; 30-day mortality also decreased from 4.4% in 2014 to 4.1% in 2017. From 2014 to 2017, there were 107,512 (4.8%) of SSHs that met the Center for Disease Control and Prevention's Electronic Health Record-based retrospective definition of sepsis.ConclusionThe VAPD 2014-2017 represents a large, standardized collection of granular data from a heterogeneous nationwide healthcare system. It is also a direct resource for studying the evolution of inpatient physiology during both acute and critical illness.