Development and validation of a mortality risk-adjustment model for patients hospitalized for exacerbations of chronic obstructive pulmonary disease.

MedStar author(s):
Citation: Medical Care. 51(7):597-605, 2013 Jul.PMID: 23604015Institution: MedStar Washington Hospital CenterDepartment: Medicine/Pulmonary-Critical CareForm of publication: Journal ArticleMedline article type(s): Journal Article | Validation StudiesSubject headings: *Hospital Mortality | *Hospitalization | *Pulmonary Disease, Chronic Obstructive/mo [Mortality] | *Pulmonary Disease, Chronic Obstructive/pp [Physiopathology] | *Risk Adjustment | Aged, 80 and over | Aged | Confidence Intervals | Electronic Health Records | Female | Humans | Male | Middle Aged | Models, Statistical | New England/ep [Epidemiology] | Odds RatioYear: 2013Local holdings: Available online from MWHC library: 1996 - presentISSN:
  • 0025-7079
Name of journal: Medical careAbstract: BACKGROUND: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a leading cause of hospitalization and death. We sought to develop and validate a mortality risk-adjustment model to enhance hospital performance measurement and to support comparative effectiveness research.CONCLUSIONS: A mortality prediction model combining clinical and administrative data that can be obtained from electronic health records demonstrated good discrimination among patients hospitalized for AECOPD. The addition of admission vital signs and laboratory results enhanced clinical validity and could be applied to future comparative effectiveness research and hospital profiling efforts.METHODS: Using a derivation cohort of 69,299 AECOPD admissions in 2005-2006 across 172 hospitals, we developed a logistic regression model with age, sex, laboratory results, vital signs, and secondary diagnosis-based comorbidities as covariates. We converted the model coefficients into a score system and validated it using 33,327 admissions from 2007. We used the c-statistic to assess model fit.RESULTS: In the derivation and validation cohorts, the median (interquartile range) age was 72 (range, 63-79) versus 71 (range, 62-79) years; 45.6% versus 45.9% were male; and in-hospital mortality rates were 3.2% versus 2.9%, respectively. The predicted probability of deaths for individuals ranged from 0.004 to 0.942 versus 0.001 to 0.933, respectively. The relative contribution of variables to the predictive ability of the derivation model was age (18.3%), admission laboratory results (39.9%), vital signs (14.7%), altered mental status (7.1%), and comorbidities (19.9%). The model c-statistic was 0.83 (95% CI: 0.82, 0.84) versus 0.84 (95% CI: 0.83, 0.85), respectively, with good calibration for both cohorts.All authors: Hyde L, Johannes RS, Lindenauer PK, Shorr AF, Sun X, Tabak YPFiscal year: FY2014Digital Object Identifier: Date added to catalog: 2013-09-17
Holdings
Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 23604015 Available 23604015

Available online from MWHC library: 1996 - present

BACKGROUND: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a leading cause of hospitalization and death. We sought to develop and validate a mortality risk-adjustment model to enhance hospital performance measurement and to support comparative effectiveness research.

CONCLUSIONS: A mortality prediction model combining clinical and administrative data that can be obtained from electronic health records demonstrated good discrimination among patients hospitalized for AECOPD. The addition of admission vital signs and laboratory results enhanced clinical validity and could be applied to future comparative effectiveness research and hospital profiling efforts.

METHODS: Using a derivation cohort of 69,299 AECOPD admissions in 2005-2006 across 172 hospitals, we developed a logistic regression model with age, sex, laboratory results, vital signs, and secondary diagnosis-based comorbidities as covariates. We converted the model coefficients into a score system and validated it using 33,327 admissions from 2007. We used the c-statistic to assess model fit.

RESULTS: In the derivation and validation cohorts, the median (interquartile range) age was 72 (range, 63-79) versus 71 (range, 62-79) years; 45.6% versus 45.9% were male; and in-hospital mortality rates were 3.2% versus 2.9%, respectively. The predicted probability of deaths for individuals ranged from 0.004 to 0.942 versus 0.001 to 0.933, respectively. The relative contribution of variables to the predictive ability of the derivation model was age (18.3%), admission laboratory results (39.9%), vital signs (14.7%), altered mental status (7.1%), and comorbidities (19.9%). The model c-statistic was 0.83 (95% CI: 0.82, 0.84) versus 0.84 (95% CI: 0.83, 0.85), respectively, with good calibration for both cohorts.

English

Powered by Koha