External Validation of the Skilled Nursing Facility Prognosis Score for Predicting Mortality, Hospital Readmission, and Community Discharge in Veterans.
External Validation of the Skilled Nursing Facility Prognosis Score for Predicting Mortality, Hospital Readmission, and Community Discharge in Veterans.
复制标题
用于预测退伍军人死亡率、再入院和社区出院的熟练护理设施预后评分的外部验证。
DOI：
10.1111/jgs.16650
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发表时间：
2020
影响因子：
6.3
通讯作者：
Ersek,Mary
中科院分区：
文献类型：
--
作者：
Burke,RobertE;Canamucio,Anne;Medvedeva,Elina;Manges,KirstinA;Ersek,Mary
需要预后工具来识别在专业护理机构（SNF）接受急性期后护理的不良结局高风险患者，并提供高价值护理。SNF预后评分是在医疗保险样本中开发的，用于预测SNF长期住院、再入院或SNF住院期间死亡的复合指标。我们的目标是评估评分在外部验证队列中的表现。研究回顾性观察分析。设置我们使用了退伍军人管理局（VA）的住宅历史文件，该文件将VA，Medicare和Medicaid索赔串联起来，以确定各个退伍军人的设置和支付者的护理轨迹。参与者以前居住在社区的退伍军人从2012年1月1日住院后在SNF接受急性后护理，至2014年12月31日。VA和非VA医院和SNFs都包括在内。测量我们计算了样本中所有合格退伍军人的五项SNF预后评分，并确定了其区分度。（使用受试者工作特性曲线）和校准（绘制观察到的和预期的事件）。在我们的样本中，386,483名退伍军人的身体功能更差，合并症更多，更有可能接受心力衰竭治疗，但他们的住院时间和导管数量都比最初的医疗保险队列要短。SNF预后评分有类似的歧视（C-统计= .70; .75在推导队列）和校准在低到中等水平的风险;在高水平，校准较差的分数高估风险的不良事件.CONCLUSIONThe SNF预后评分有合理的歧视和校准，它是简单的计算使用入院SNF评估和诺模图。未来的工作需要将分数嵌入实践，以确定真实的世界的可行性，可接受性和有效性。
BACKGROUND/OBJECTIVESPrognostic tools are needed to identify patients at high risk for adverse outcomes receiving post‐acute care in skilled nursing facilities (SNFs) and provide high‐value care. The SNF Prognosis Score was developed in a Medicare sample to predict a composite of long‐term SNF stay, hospital readmission, or death during the SNF stay. Our goal was to evaluate the score's performance in an external validation cohort.DESIGNRetrospective observational analysis.SETTINGWe used a Veterans Administration (VA) Residential History File that concatenates VA, Medicare, and Medicaid claims to identify care trajectories across settings and payers for individual veterans.PARTICIPANTSPreviously community‐dwelling veterans receiving post‐acute care in a SNF after hospitalization from January 1, 2012, to December 31, 2014. Both VA and non‐VA hospitals and SNFs were included.MEASUREMENTSWe calculated the five‐item SNF Prognosis Score for all eligible veterans in our sample and determined its discrimination (using a receiver operating characteristic curve) and calibration (plotting observed and expected events).RESULTSThe 386,483 veterans in our sample had worse physical function, more comorbidities, and were more likely to be treated for heart failure, but they had shorter index hospital lengths of stay and fewer catheters than the original Medicare cohort. The SNF Prognosis Score had similar discrimination (C‐statistic = .70; .75 in the derivation cohort) and calibration at low to moderate levels of risk; at high levels, calibration was poorer with the score overestimating risks of adverse events.CONCLUSIONThe SNF Prognosis Score has reasonable discrimination and calibration, and it is simple to calculate using an admission SNF assessment and a nomogram. Future work embedding the score into practice is needed to determine real‐world feasibility, acceptability, and effectiveness.