Using an Automated Electronic Health Record Score To Estimate Life Expectancy In Men Diagnosed With Prostate Cancer In The Veterans Health Administration.
Using an Automated Electronic Health Record Score To Estimate Life Expectancy In Men Diagnosed With Prostate Cancer In The Veterans Health Administration.
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DOI：
10.1016/j.urology.2021.05.056
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发表时间：
2021-09
期刊：
影响因子：
2.1
通讯作者：
Leppert JT
中科院分区：
文献类型：
--
作者：
Soerensen SJC;Thomas IC;Schmidt B;Daskivich TJ;Skolarus TA;Jackson C;Osborne TF;Chertow GM;Brooks JD;Rehkopf DH;Leppert JT
确定自动计算的电子健康记录评分是否可以估计前列腺癌男性的中期预期寿命，以提供指南一致的护理。我们在VHA中确定了2013-2015年诊断为前列腺癌的所有男性（n= 36，591）。在36，591名患者中，35，364名（96.6%）在诊断日期前30天内自动计算了护理评估需求（CAN）评分（范围：0-99）。它旨在估计住院和死亡的短期风险。我们拟合了未校正的多变量考克斯比例风险回归模型，以确定前列腺癌患者CAN评分与总生存率之间的关系。我们比较了CAN评分与两个已建立的合并症指标：Charlson合并症指数和前列腺癌合并症指数（PCCI）。在35,364名男性中，CAN评分与总体分期相关，局限性、局部晚期和转移性疾病的平均评分分别为46.5（±22.4）、58.0（±24.4）和68.1（±24.3）。在未校正和校正的前列腺癌风险模型中，CAN评分与生存率独立相关（HR=1.23 95%CI 1.22-1.24和校正HR=1.17 95%CI 1.16-1.18/5单位变化）。对于5年生存率，CAN评分（总体C指数0.74）比PCCI（AUC=0.65）或Charlson合并症指数（AUC=0.66）产生更好的区分度（AUC = 0.76）。CAN评分与前列腺癌诊断后的中期生存率密切相关。CAN评分是学习型医疗保健系统如何实施多维工具以提供全自动预期寿命估计以促进以患者为中心的癌症护理的一个例子。
To determine if an automatically calculated electronic health record score can estimate intermediate-term life expectancy in men with prostate cancer to provide guideline concordant care. We identified all men (n=36,591) diagnosed with prostate cancer in 2013–2015 in the VHA. Of the 36,591, 35,364 (96.6%) had an available Care Assessment Needs (CAN) score (range: 0–99) automatically calculated in the 30 days prior to the date of diagnosis. It was designed to estimate short-term risks of hospitalization and mortality. We fit unadjusted and multivariable Cox proportional hazards regression models to determine the association between the CAN score and overall survival among men with prostate cancer. We compared CAN score performance to two established comorbidity measures: The Charlson Comorbidity Index and Prostate Cancer Comorbidity Index (PCCI). Among 35,364 men, the CAN score correlated with overall stage, with mean scores of 46.5 (±22.4), 58.0 (±24.4), and 68.1 (±24.3) in localized, locally advanced, and metastatic disease, respectively. In both unadjusted and adjusted models for prostate cancer risk, the CAN score was independently associated with survival (HR=1.23 95%CI 1.22–1.24 & adjusted HR=1.17 95%CI 1.16–1.18 per 5-unit change, respectively). The CAN score (overall C-Index 0.74) yielded better discrimination (AUC=0.76) than PCCI (AUC=0.65) or Charlson Comorbidity Index (AUC=0.66) for 5-year survival. The CAN score is strongly associated with intermediate-term survival following a prostate cancer diagnosis. The CAN score is an example of how learning health care systems can implement multi-dimensional tools to provide fully automated life expectancy estimates to facilitate patient-centered cancer care.
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影响因子：
3.3
作者：
Sohn MW;Arnold N;Maynard C;Hynes DM
通讯作者：
Hynes DM
影响因子：
7.2
作者：
DEYO, RA;CHERKIN, DC;CIOL, MA
通讯作者：
CIOL, MA
影响因子：
6.6
作者：
Daskivich, Timothy J.;Kwan, Lorna;Litwin, Mark S.
通讯作者：
Litwin, Mark S.
影响因子：
6.2
作者：
Daskivich, Timothy J.;Chamie, Karim;Litwin, Mark S.
通讯作者：
Litwin, Mark S.
影响因子：
39.2
作者：
Keating, Nancy L.;Landrum, Mary Beth;McNeil, Barbara J.
通讯作者：
McNeil, Barbara J.