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Optimizing Risk-Adjustment for Measuring ICU Quality

优化风险调整以衡量 ICU 质量

基本信息

批准号：
6528273
负责人：
LAURENT Gilles GLANCE
金额：
$ 11.44万
依托单位：
UNIVERSITY OF ROCHESTER
依托单位国家：
美国
项目类别：
财政年份：
2000
资助国家：
美国
起止时间：
2000-09-01 至 2003-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/6528273
关键词：
clinical research health care model health care quality health services research tag human data human mortality intensive care outcomes research

项目摘要

The purpose of this career development award is to develop a research and training program that will enable Dr. Glance to become an independent physician investigator in the field of health outcomes research. The focus of this proposal will be to examine the feasibility of using risk-adjustment models for benchmarking Intensive Care Unit (ICU) performance in a large multi-institutional database. Crude mortality rates cannot be used to compare ICUs because they do not account for differences in the severity of disease between ICU patient populations. However, the Standardized Mortality Ratio (SMR), defined as the ratio of the observed mortality rate (OMR) to the expected mortality rate (EMR), does account for differences in patient case mix between ICUs, and can therefore be used to compare the performance of individual ICUs. The EMR is obtained by calculating the predicted mortality of the patients in a specific population using an ICU scoring system. Using severity-adjusted outcome measures like the SMR, low- and high-performance ICUs can be identified. A potential problem with this approach is the finding that general severity scoring systems disagree on how to rank individual hospitals using severity-adjusted outcome measures. It is likely that ICU scoring systems will behave in the same manner; Specific Aim #1 will examine this hypothesis for APACHE 11 (Acute Physiology and Chronic Health Evaluation), SAPS 11 (Simplified Acute Physiology Score) and MPM II (Mortality Probability Model). A finding that different scoring systems disagree on the identity of quality outliers raises doubt regarding the face validity of benchmarking efforts using severity-adjusted outcome measures. Validation studies have demonstrated that ICU scoring systems perform poorly when evaluated in most data sets (other than the one used to develop the original model). Therefore, it not surprising that severity-adjusted outcome measures do not agree on hospital quality when the scoring systems on which they are based are not accurate. However, predictive models can be customized to a data set so that they will more accurately predict outcomes within that data set. Specific Aim #2 will examine the proposition that ICU scoring systems are more likely to agree on the identity of quality outliers after the scoring systems have been customized to the ICU database made up of the ICUs whose performance is being benchmarked.

该职业发展奖的目的是开发一个研究和培训计划，使Glance博士成为健康结果研究领域的独立医生调查员。本提案的重点是研究在大型多机构数据库中使用风险调整模型对重症监护室（ICU）绩效进行基准测试的可行性。粗死亡率不能用于比较ICU，因为它们不能解释ICU患者人群之间疾病严重程度的差异。然而，标准化死亡率（SMR）（定义为观察死亡率（OMR）与预期死亡率（EMR）的比值）确实说明了ICU之间患者病例组合的差异，因此可用于比较单个ICU的性能。EMR通过使用ICU评分系统计算特定人群中患者的预测死亡率来获得。使用严重程度调整的结果指标（如SMR），可以识别低性能和高性能ICU。这种方法的一个潜在问题是，发现一般的严重程度评分系统不同意如何使用严重程度调整后的结果措施对个别医院进行排名。ICU评分系统很可能会以相同的方式表现;具体目标#1将针对APACHE 11（急性生理学和慢性健康评价）、SAPS 11（简化急性生理学评分）和MPM II（死亡概率模型）检查该假设。不同的评分系统不同意的质量离群值的身份，这一发现引起了怀疑的表面有效性基准的努力，使用严重程度调整的结果措施。验证研究表明，ICU评分系统在大多数数据集（而不是用于开发原始模型的数据集）中进行评估时表现不佳。因此，当严重程度调整后的结果指标所基于的评分系统不准确时，它们对医院质量的看法不一致也就不足为奇了。然而，预测模型可以根据数据集进行定制，以便更准确地预测该数据集中的结果。具体目标#2将检查以下命题：在评分系统针对ICU数据库（由其性能正在进行基准测试的ICU组成）进行定制后，ICU评分系统更有可能就质量离群值的身份达成一致。