The Kaiser Permanente inpatient risk adjustment methodology was valid in an external patient population
The Kaiser Permanente inpatient risk adjustment methodology was valid in an external patient population
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DOI：
10.1016/j.jclinepi.2009.08.020
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发表时间：
2010-07-01
影响因子：
7.2
通讯作者：
Forster, Alan J.
中科院分区：
文献类型：
--
作者：
van Walraven, Carl;Escobar, Gabriel J.;Forster, Alan J.
目的：准确预测住院死亡率是衡量和比较病人护理的必要条件。需要对预测模型进行外部验证，以真正证明其效用。本研究评估了Kaiser Permanente住院风险调整方法的医院死亡率在一个病人群体中使用的不同，用于其derivation.Study设计和设置：回顾性队列研究，在两家医院在渥太华，加拿大，包括所有住院患者在1998年1月和2002年4月（n = 188，724）。住院病人死亡率的统计模型是在随机的一半队列中推导出来的，并在另一半队列中进行验证。使用原始参数估计值的模型具有极好的区分度（c-统计量89.4，95%置信区间[CI] 0.891-0.898），但校准较差。使用基于数据的参数估计值，区分度极好（c-统计量0.915，95% CI 0.912-0.918），当使用Elixhauser指数（0.901，0.898-0.904）或Charlson指数（0.894，0.891-0.897）在模型中表示患者合并症时，区分度仍然良好。结论：Kaiser Permanente住院病人风险调整方法是一种有效的预测住院死亡风险的模型。无论采用何种方法总结患者合并症，其表现均同样良好。(C)2010年由Elsevier Inc.出版
Objectives: Accurately predicting hospital mortality is necessary to measure and compare patient care. External validation of predictive models is required to truly prove their utility. This study assessed the Kaiser Permanente inpatient risk adjustment methodology for hospital mortality in a patient population distinct from that used for its derivation.Study Design and Setting: Retrospective cohort study at two hospitals in Ottawa, Canada, involving all inpatients admitted between January 1998 and April 2002 (n = 188,724). Statistical models for inpatient mortality were derived on a random half of the cohort and validated on the other half.Results: Inpatient mortality was 3.3%. The model using original parameter estimates had excellent discrimination (c-statistic 89.4, 95% confidence interval [CI] 0.891-0.898) but poor calibration. Using data-based parameter estimates, discrimination was excellent (c-statistic 0.915, 95% Cl 0.912-0.918) and remained so when patient comorbidity was expressed in the model using the Elixhauser Index (0.901, 0.898-0.904) or the Charlson Index (0.894, 0.891-0.897). These models accurately predicted the risk of hospital death.Conclusion: The Kaiser Permanente inpatient risk adjustment methodology is a valid model for predicting hospital mortality risk. It performed equally well regardless of methods used to summarize patient comorbidity. (C) 2010 Published by Elsevier Inc.