High-risk diagnosis combinations in patients undergoing interhospital transfer: a retrospective observational study.
High-risk diagnosis combinations in patients undergoing interhospital transfer: a retrospective observational study.
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DOI：
10.1186/s12873-022-00742-1
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发表时间：
2022-11-24
影响因子：
2.5
通讯作者：
中科院分区：
文献类型：
--
作者：
关于导致转移后患者死亡率较高的个体患者特征（单独或组合）的研究有限。这项工作的目的是确定显着的组合诊断，确定亚组的医院间转移后的患者经历的死亡率最高的水平。这是一项回顾性横断面研究，使用了2010-2017年区域卫生系统的结构化电子健康记录数据。我们采用了机器学习的方法，关联规则挖掘使用Apriori算法来识别诊断组合。研究人群包括所有21岁及以上的患者，这些患者在我们的卫生系统内从社区医院转移到三家主要接收医院之一。共有8893例患者纳入分析。发生转移后死亡的患者平均年龄较大（70.5岁vs 62.6岁），平均在6个诊断子类别中的5个诊断中有更多诊断。在诊断子类别中，大多数诊断是合并症和活动性医学问题，其中高血压、房颤和急性呼吸衰竭是最常见的。几种诊断组合确定了院间转移后死亡率超过50%的患者。合并症负担，结合积极的医疗问题，是最预测那些经历死亡率最高的。进一步提高患者水平的精确度可以促进提供者和患者之间的知情决策，以将范式从将所有患者转移到更高水平的护理转变为仅转移那些将受益或希望继续护理的患者，并减少无效的转移。
There is limited research on individual patient characteristics, alone or in combination, that contribute to the higher levels of mortality in post-transfer patients. The purpose of this work is to identify significant combinations of diagnoses that identify subgroups of post-interhospital transfer patients experiencing the highest levels of mortality. This was a retrospective cross-sectional study using structured electronic health record data from a regional health system between 2010–2017. We employed a machine learning approach, association rules mining using the Apriori algorithm to identify diagnosis combinations. The study population includes all patients aged 21 and older that were transferred within our health system from a community hospital to one of three main receiving hospitals. Overall, 8893 patients were included in the analysis. Patients experiencing mortality post-transfer were on average older (70.5 vs 62.6 years) and on average had more diagnoses in 5 of the 6 diagnostic subcategories. Within the diagnostic subcategories, most diagnoses were comorbidities and active medical problems, with hypertension, atrial fibrillation, and acute respiratory failure being the most common. Several combinations of diagnoses identified patients that exceeded 50% post-interhospital transfer mortality. Comorbid burden, in combination with active medical problems, were most predictive for those experiencing the highest rates of mortality. Further improving patient level prognostication can facilitate informed decision making between providers and patients to shift the paradigm from transferring all patients to higher level care to only transferring those who will benefit or desire continued care, and reduce futile transfers.
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影响因子：
5.7
作者：
Ranasinghe, Isuru;Barzi, Federica;Gallagher, Martin
通讯作者：
Gallagher, Martin
DOI：
10.1186/cc13981
发表时间：
2014-07-09
期刊：
Critical care (London, England)
影响因子：
--
作者：
Abe T;Takahashi O;Saitoh D;Tokuda Y
通讯作者：
Tokuda Y
DOI：
10.1161/circoutcomes.116.003414
发表时间：
2017-06-01
影响因子：
6.9
作者：
Kragholm, Kristian;Hansen, Carolina Malta;Granger, Christopher B.
通讯作者：
Granger, Christopher B.
影响因子：
2.6
作者：
Mueller, Stephanie K.;Fiskio, Julie;Schnipper, Jeffrey
通讯作者：
Schnipper, Jeffrey
影响因子：
6.3
作者：
Ho, Vanessa P.;Schiltz, Nicholas K.;Koroukian, Siran M.
通讯作者：
Koroukian, Siran M.