Procedure-based severity index for inpatients: development and validation using administrative database.
Procedure-based severity index for inpatients: development and validation using administrative database.
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DOI：
10.1186/s12913-015-0889-x
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发表时间：
2015-07-08
影响因子：
2.8
通讯作者：
Yasunaga H
中科院分区：
文献类型：
--
作者：
Yamana H;Matsui H;Fushimi K;Yasunaga H
风险调整在使用行政数据库的研究中很重要。尽管诊断和治疗程序的使用可以代表患者的严重程度，但程序记录在风险调整中的可用性并未得到很好的证明。因此，我们的目标是开发和验证一个可以根据手术记录计算的严重程度指数。使用日本全国急诊医院诊断程序组合数据库，我们确定了2012年4月1日至2013年3月31日期间出院的患者，他们被诊断为急性心肌梗死、充血性心力衰竭、急性脑血管疾病、胃肠道出血、肺炎或败血症。受试者被随机分配到派生队列或验证队列。在推导队列中，我们使用多变量Logistic回归分析来确定入院日进行的操作与住院死亡显著相关，并为每个操作分配一个与回归系数相对应的点。然后在验证队列中计算一个指数作为所执行手术的积分总和，并使用该指数和其他患者特征来评估死亡率预测模型的性能。在纳入的539 385例住院患者中，270 054例和269 331例分别被分配到派生和验证队列。从派生队列中确定了19个重要步骤，得分范围从−3到23，产生了可能范围为−13到69的严重程度指数。在验证队列中，死亡率预测模型的c统计量为0.767(95%可信区间：0.764-0.770)。代表该指数相对于其他变量贡献的ω统计量为1.09(95%可信区间：1.03-1.17)。基于程序的严重程度指数对死亡率有很好的预测作用，表明行政数据库中的程序记录对风险调整是有用的。本文的在线版本(doi：10.1186/s12913-0150889-x)包含补充材料，授权用户可以使用。
Risk adjustment is important in studies using administrative databases. Although utilization of diagnostic and therapeutic procedures can represent patient severity, the usability of procedure records in risk adjustment is not well-documented. Therefore, we aimed to develop and validate a severity index calculable from procedure records. Using the Japanese nationwide Diagnosis Procedure Combination database of acute-care hospitals, we identified patients discharged between 1 April 2012 and 31 March 2013 with an admission-precipitating diagnosis of acute myocardial infarction, congestive heart failure, acute cerebrovascular disease, gastrointestinal hemorrhage, pneumonia, or septicemia. Subjects were randomly assigned to the derivation cohort or the validation cohort. In the derivation cohort, we used multivariable logistic regression analysis to identify procedures performed on admission day which were significantly associated with in-hospital death, and a point corresponding to regression coefficient was assigned to each procedure. An index was then calculated in the validation cohort as sum of points for performed procedures, and performance of mortality-predicting model using the index and other patient characteristics was evaluated. Of the 539 385 hospitalizations included, 270 054 and 269 331 were assigned to the derivation and validation cohorts, respectively. Nineteen significant procedures were identified from the derivation cohort with points ranging from −3 to 23, producing a severity index with possible range of −13 to 69. In the validation cohort, c-statistic of mortality-predicting model was 0.767 (95 % confidence interval: 0.764–0.770). The ω-statistic representing contribution of the index relative to other variables was 1.09 (95 % confidence interval: 1.03–1.17). Procedure-based severity index predicted mortality well, suggesting that procedure records in administrative database are useful for risk adjustment. The online version of this article (doi:10.1186/s12913-015-0889-x) contains supplementary material, which is available to authorized users.
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