Effect of changes over time in the performance of a customized SAPS-II model on the quality of care assessment
Effect of changes over time in the performance of a customized SAPS-II model on the quality of care assessment
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DOI：
10.1007/s00134-011-2390-2
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发表时间：
2012-01-01
影响因子：
38.9
通讯作者：
Abu-Hanna, Ameen
中科院分区：
文献类型：
--
作者：
Minne, Lilian;Eslami, Saeid;Abu-Hanna, Ameen
目的：我们研究的目的是使用创新方法探索现有模型死亡率预测性能的时间变化对护理质量评估的影响。预后模型 (rSAPS-II) 是为高龄重症监护病房 (ICU) 患者开发的重新校准的简化急性生理学评分 II 模型。方法：研究人群包括 2004 年 1 月至 2009 年 7 月期间入住荷兰 21 家医院 ICU 的所有连续 12,143 名 80 岁及以上患者。预期数据集被分为 30 个大小相等的连续子集。对于每个子集，我们测量了模型的辨别力 [曲线下面积 (AUC)]、准确性（Brier 评分）和标准化死亡率 (SMR)，无论是未经重复重新校准还是经过重复重新校准。如果 1 没有或经过 2009 年重复重新校准，则所有性能测量均被认为是稳定的。 结果：对于所有子集，AUC 稳定，但 Brier 评分和 SMR 不稳定。 SMR 呈下降趋势，达到显着低于 1 的水平。反复重新校准使其再次稳定。 SMR>1及SMR的医院比例
Purpose: The aim of our study was to explore, using an innovative method, the effect of temporal changes in the mortality prediction performance of an existing model on the quality of care assessment. The prognostic model (rSAPS-II) was a recalibrated Simplified Acute Physiology Score-II model developed for very elderly Intensive Care Unit (ICU) patients. Methods: The study population comprised all 12,143 consecutive patients aged 80 years and older admitted between January 2004 and July 2009 to one of the ICUs of 21 Dutch hospitals. The prospective dataset was split into 30 equally sized consecutive subsets. Per subset, we measured the model's discrimination [area under the curve (AUC)], accuracy (Brier score), and standardized mortality ratio (SMR), both without and after repeated recalibration. All performance measures were considered to be stable if 1 without and after repeated recalibration for the year 2009. Results: For all subsets, the AUCs were stable, but the Brier scores and SMRs were not. The SMR was downtrending, achieving levels significantly below 1. Repeated recalibration rendered it stable again. The proportions of hospitals with SMR>1 and SMR