Adaptation of the Acute Organ Failure Score for Use in a Medicare Population
Adaptation of the Acute Organ Failure Score for Use in a Medicare Population
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DOI：
10.1097/ccm.0000000000002651
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发表时间：
2017-11-01
影响因子：
8.8
通讯作者：
Kerlin, Meeta Prasad
中科院分区：
文献类型：
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作者：
Courtright, Katherine R.;Halpern, Scott D.;Kerlin, Meeta Prasad
目的：没有广泛可用的生理数据，需要ICU的风险调整方法，可以应用于管理数据。我们试图通过将急性器官衰竭评分调整为一个常用的管理数据库来扩大其普遍性。设计：回顾性队列研究。设置：宾夕法尼亚州的151家医院。患者：2009年1月1日至2009年12月1日期间，77,040名独特患者中共有90,733名ICU入院，测量和主要结果：我们在随机分组队列中使用多变量逻辑回归来预测30天死亡率，并检查在模型中使用不同的合并因素测量和添加历史索赔数据的影响。总体30天死亡率为17.6%。在验证队列中，使用原始急性器官衰竭评分模型的β系数导致区分度较差（C统计量，0.644; 95%CI，0.639-0.649）。当使用医疗保险队列重新校准β系数时，模型的C统计量提高到0.721（95%CI，0.711-0.730）。当合并症被表示为合并症点评分2（C-统计量，0.737; 95%CI，0.728-0.747; p < 0.001）或Elixhauser指数（C-统计量，0.748; 95%CI，0.739-0.757）而不是Charlson指数时，模型辨别力进一步提高。添加历史索赔数据增加了合并症的数量确定，但没有提高模型performance.Conclusions：修改的急性器官衰竭评分导致良好的模型歧视不同人群中，无论合并症的措施。本研究扩展了急性器官衰竭评分在ICU研究中的风险调整和使用标准管理数据的结局报告的使用。
Objectives: Without widely available physiologic data, a need exists for ICU risk adjustment methods that can be applied to administrative data. We sought to expand the generalizability of the Acute Organ Failure Score by adapting it to a commonly used administrative database.Design: Retrospective cohort study.Setting: One hundred fifty-one hospitals in Pennsylvania.Patients: A total of 90,733 ICU admissions among 77,040 unique patients between January 1, 2009, and December 1, 2009, in the Medicare Provider Analysis and Review database.Measurements and Main Results: We used multivariable logistic regression on a random split cohort to predict 30-day mortality, and to examine the impact of using different comorbidity measures in the model and adding historical claims data. Overall 30-day mortality was 17.6%. In the validation cohort, using the original Acute Organ Failure Score model's beta coefficients resulted in poor discrimination (C-statistic, 0.644; 95% CI, 0.639-0.649). The model's C-statistic improved to 0.721 (95% CI, 0.711-0.730) when the Medicare cohort was used to recalibrate the beta coefficients. Model discrimination improved further when comorbidity was expressed as the COmorbidity Point Score 2 (C-statistic, 0.737; 95% CI, 0.728-0.747; p < 0.001) or the Elixhauser index (C-statistic, 0.748; 95% CI, 0.739-0.757) instead of the Charlson index. Adding historical claims data increased the number of comorbidities identified, but did not enhance model performance.Conclusions: Modification of the Acute Organ Failure Score resulted in good model discrimination among a diverse population regardless of comorbidity measure used. This study expands the use of the Acute Organ Failure Score for risk adjustment in ICU research and outcomes reporting using standard administrative data.