METHODS FOR SURVIVAL ANALYSIS IN OUTCOMES RESEARCH

结果研究中的生存分析方法

• 批准号: 2235956
• 负责人: WILLIAM A KNAUS
• 金额: $ 23.1万
• 依托单位: GEORGE WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 1992
• 资助国家: 美国
• 起止时间: 1992-09-30 至 1995-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/2235956
• 关键词: critical care; data collection methodology /evaluation; health care cost /financing; health care model; health care professional practice; health care quality; health care service evaluation; health care service utilization; hospital patient care; hospital utilization; human subject; information systems; intensive care; mathematical model; model design /development; patient care management; prognosis

A major component of the growth in size and cost of the U.S.'s health care system is the increasingly aggressive treatment of acute and chronic disease at more advanced stages of illness. Most of this care is concentrated in hospitals an much is located within Intensive Care Units, whose size and contribution to total health care costs is increasing dramatically. The goal of this proposal is to advance the analytic capabilities of basic health services research as they relate to survival analysis or risk prediction for critically ill hospitalized adults (CIHAs) treated in hospitals and ICUs and to link these findings to the evaluation of patient outcome, costs, quality of care, utilization and practice patterns and, ultimately, to the improvement of clinical decision making. The long term objective is to use clinically accurate data bases to explore limitations and shortcomings of current efforts at survival analysis and risk prediction and suggest improvements. Such progress will be of substantial benefit to researchers, quality assurance for CIHAs. We will accomplish this by making use of two contemporary, clinically accurate data bases containing detailed disease and physiologic information on over 25,000 CIHAs. Within these data bases we will determine how variations in missing values, selection of the patient for treatment, and the interaction of major predictive components influence the overall explanatory power of survival analyses. We will also explore how various multivariable techniques and length of follow up influence determinations of the quality, cost-efficiency and appropriateness of care. From these analyses we will propose analytic approaches, develop guidelines, and suggest standards that could be used to evaluate the quality of evidence rom inter-institutional evaluations of CIHA as well as evaluating the usefulness of individual patient outcome predictions for use in conjunction with traditional clinical decision making.

美国医疗保健规模和成本增长的主要组成部分 系统正在日益积极地治疗急性和慢性疾病 疾病处于更晚期阶段。 这种护理大部分是 集中在医院，大部分位于重症监护室， 其规模和对医疗保健总成本的贡献正在增加 戏剧性地。 该提案的目标是提高基本分析能力 与生存分析或风险相关的卫生服务研究 对接受治疗的危重住院成人 (CIHA) 的预测 医院和 ICU 并将这些发现与患者的评估联系起来 结果、成本、护理质量、利用和实践模式，以及 最终，改善临床决策。 长期来看 目标是使用临床准确的数据库来探索局限性 当前生存分析和风险工作的缺点 预测并提出改进建议。 这样的进展将是实质性的 研究人员受益，CIHA 的质量保证。 我们将通过利用两种当代的临床方法来实现这一目标 包含详细疾病和生理信息的准确数据库 超过 25,000 个 CIHA。 在这些数据库中，我们将确定如何 缺失值的变化、治疗患者的选择，以及 主要预测成分的相互作用影响整体 生存分析的解释力。 我们还将探讨如何不同 多变量技术和后续影响确定的时间长度 护理的质量、成本效益和适当性。 从这些 分析我们将提出分析方法、制定指导方针，以及 提出可用于评估证据质量的标准 CIHA 的机构间评估以及评估 结合使用个体患者结果预测的有用性 与传统的临床决策。

项目成果

Severity stratification and outcome prediction for multisystem organ failure and dysfunction.

多系统器官衰竭和功能障碍的严重程度分层和结果预测。

• DOI: 10.1007/s002689900063
• 发表时间: 1996
• 期刊: World journal of surgery
• 影响因子: 2.6
• 作者: Zimmerman,JE;Knaus,WA;Sun,X;Wagner,DP
• 通讯作者: Wagner,DP

The importance of technology for achieving superior outcomes from intensive care. Brazil APACHE III Study Group.

技术对于实现重症监护的卓越结果的重要性。

• DOI: 10.1007/bf01709743
• 发表时间: 1996
• 期刊: Intensive care medicine
• 影响因子: 38.9
• 作者: Bastos,PG;Knaus,WA;Zimmerman,JE;MagalhãesJr,A;Sun,X;Wagner,DP
• 通讯作者: Wagner,DP

The use of APACHE III to evaluate ICU length of stay, resource use, and mortality after coronary artery by-pass surgery.

使用 APACHE III 评估冠状动脉搭桥手术后的 ICU 住院时间、资源使用和死亡率。

• 发表时间: 1995
• 期刊: The Journal of cardiovascular surgery
• 作者: Becker,RB;Zimmerman,JE;Knaus,WA;Wagner,DP;Seneff,MG;Draper,EA;Higgins,TL;Estafanous,FG;Loop,FD
• 通讯作者: Loop,FD