Pulse oximetry and supplemental oxygen use in nationwide Veterans Health Administration hospitals, 2013-2017: a Veterans Affairs Patient Database validation study.
Pulse oximetry and supplemental oxygen use in nationwide Veterans Health Administration hospitals, 2013-2017: a Veterans Affairs Patient Database validation study.
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DOI：
10.1136/bmjopen-2021-051978
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发表时间：
2021-10-08
期刊：
影响因子：
2.9
通讯作者：
Seelye S
中科院分区：
文献类型：
--
作者：
Wang XQ;Iwashyna T;Prescott H;Valbuena V;Seelye S
从电子健康记录中提取和标准化脉搏血氧饱和度和辅助供氧数据有可能改善风险调整、质量评估和说明。我们开发了一种标准化方法，并报告其用于基准测试的情况。使用来自全国退伍军人事务医疗保健系统（2013-2017）的电子健康记录数据，我们提取，标准化和验证了退伍军人事务患者数据库（VAPD）队列研究中2765446例住院的脉搏血氧饱和度和补充供氧数据。我们分别使用以下方法评估了面效度、同期效度和预测效度：（1）评估24小时内患者脉搏血氧饱和度值的稳定性，（2）测试可能需要氧疗的患者是否使用了更大量的补充氧气，（3）检查补充氧气与随后死亡率之间的相关性。我们发现，2 700 922例（98%）住院患者至少有一次脉搏血氧仪阅读，864 605例（31%）住院患者接受了氧疗。通过脉搏血氧仪监测的患者平均每6小时进行一次阅读（中位数4; IQR 3-7）。与未接受氧疗的患者相比，接受辅助供氧的患者年龄较大，为白色男性（p<0.001），更可能诊断为心力衰竭和慢性肺部疾病（p<0.001）。在24小时内记录到至少3个连续值的患者的补充氧气量波动中位数为2 L/min（IQR：2-3），81%的三胞胎显示相同的氧气接收水平。我们对脉搏血氧饱和度和辅助供氧数据进行标准化的方法显示了以下方面的正面有效性、并发有效性和预测有效性：（表面有效性）;对于某些临床状况，（同时有效性），并且辅助供氧与住院和出院后死亡率相关（预测有效性）。
Extraction and standardisation of pulse oximetry and supplemental oxygen data from electronic health records has the potential to improve risk-adjustment, quality assessment and prognostication. We develop an approach to standardisation and report on its use for benchmarking purposes. Using electronic health record data from the nationwide Veteran’s Affairs healthcare system (2013–2017), we extracted, standardised and validated pulse oximetry and supplemental oxygen data for 2 765 446 hospitalisations in the Veteran’s Affairs Patient Database (VAPD) cohort study. We assessed face, concurrent and predictive validities using the following approaches, respectively: (1) evaluating the stability of patients’ pulse oximetry values during a 24-hour period, (2) testing for greater amounts of supplemental oxygen use in patients likely to need oxygen therapy and (3) examining the association between supplemental oxygen and subsequent mortality. We found that 2 700 922 (98%) hospitalisations had at least one pulse oximetry reading, and 864 605 (31%) hospitalisations received oxygen therapy. Patients monitored by pulse oximetry had a reading on average every 6 hours (median 4; IQR 3–7). Patients on supplemental oxygen were older, white and male compared with patients not receiving oxygen therapy (p<0.001) and were more likely to have diagnoses of heart failure and chronic pulmonary diseases (p<0.001). The amount of supplemental oxygen for patients with at least three consecutive values recorded during a 24-hour period fluctuated by median 2 L/min (IQR: 2–3), and 81% of such triplets showed the same level of oxygen receipt. Our approach to standardising pulse oximetry and supplemental oxygen data shows face, concurrent and predictive validities as the following: supplemental oxygen clusters in the range consistent with hospital wall-dispensed oxygen supplies (face validity); there are greater amounts of supplemental oxygen for certain clinical conditions (concurrent validity) and there is an association of supplemental oxygen with in-hospital and postdischarge mortality (predictive validity).
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影响因子：
9.7
作者：
Fihn, Stephan D.;Francis, Joseph;Graham, Gail L.
通讯作者：
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影响因子：
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作者：
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通讯作者：
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DOI：
10.1080/21548331.2020.1845018
发表时间：
2021-03-15
期刊：
HOSPITAL PRACTICE
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作者：
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通讯作者：
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作者：
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通讯作者：
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