Evaluation of a risk-adjustment model for pressure ulcer development using the Minimum Data Set.
Evaluation of a risk-adjustment model for pressure ulcer development using the Minimum Data Set.
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使用最小数据集评估压疮发生的风险调整模型。
DOI：
10.1046/j.1532-5415.2001.49176.x
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发表时间：
2001
影响因子：
6.3
通讯作者：
Moskowitz,MA
中科院分区：
文献类型：
--
作者：
Berlowitz,DR;Brandeis,GH;Anderson,JJ;Ash,AS;Kader,B;Morris,JN;Moskowitz,MA
目的：为了验证一个先前推导出的风险调整模型的压疮发展在一个单独的样本的养老院居民，并确定在何种程度上使用该模型影响判断的养老院performance.Design：回顾性观察研究使用最小数据集（MDS）的数据从1998.SETTING：一个大型的，以营利为目的，nursingchain.Participants：29040观察了13，457养老院居民谁没有压疮的指数assessment.MEASUREMENTS：我们使用逻辑回归在我们的验证样本计算新的系数为17个先前确定的预测因素的压疮发展。从这个新的样本的系数进行了比较，与以前得出的。压疮发展的预期率确定为108家疗养院。未调整和风险调整率的压疮发展，从这些家庭也计算和离群值识别使用这两种方法进行了compared.RESULTS：预测的压疮发展的衍生样本中一般表现出类似的效果，在验证样本。模型c统计量也保持不变，为0.73，但在验证样本中也未进行校准。在将该模型应用于疗养院时，溃疡发展的预期率范围为1.1%至3.2%（P<0.001）。观察到的发生率范围为0%至12.1%（P<0.001）。有12个离群值使用未调整的利率和15个使用调整后的性能。10家疗养院被确定为离群值使用这两种approachs.CONCLUSIONS：我们的MDS风险调整模型的压疮发展表现良好，在这个新的样本。疗养院在压疮发展的预期速度上有显著差异。离群值识别也因评价的是未调整性能还是风险调整性能而异。
OBJECTIVE:To validate a previously derived risk‐adjustment model for pressure ulcer development in a separate sample of nursing home residents and to determine the extent to which use of this model affects judgments of nursing home performance.DESIGN:Retrospective observational study using Minimum Data Set (MDS) data from 1998.SETTING:A large, for‐profit, nursing home chain.PARTICIPANTS:Twenty‐nine thousand and forty observations were made on 13,457 nursing home residents who were without a pressure ulcer on an index assessment.MEASUREMENTS:We used logistic regression in our validation sample to calculate new coefficients for the 17 previously identified predictors of pressure ulcer development. Coefficients from this new sample were compared with those previously derived. Expected rates of pressure ulcer development were determined for 108 nursing homes. Unadjusted and risk‐adjusted rates of pressure ulcer development from these homes were also calculated and outlier identification using these two approaches was compared.RESULTS:Predictors of pressure ulcer development in the derivation sample generally showed similar effects in the validation sample. The model c‐statistic was also unchanged at 0.73, but it was not calibrated as well in the validation sample. On applying the model to the nursing homes, expected rates of ulcer development ranged from 1.1% to 3.2% (P< .001). The observed rates ranged from 0% to 12.1% (P< .001). There were 12 outliers using unadjusted rates and 15 using adjusted performance. Ten nursing homes were identified as outliers using both approaches.CONCLUSIONS:Our MDS risk‐adjustment model for pressure ulcer development performed well in this new sample. Nursing homes differ significantly in their expected rates of pressure ulcer development. Outlier identification also differs depending on whether unadjusted or risk‐adjusted performance is evaluated.