基于电子简化急性生理学评分的综合医疗体系中危重症风险调整评分。

An electronic Simplified Acute Physiology Score-based risk adjustment score for critical illness in an integrated healthcare system.

机构信息

Kaiser Permanente Division of Research and Systems Research Initiative, Oakland, CA, USA.

出版信息

Crit Care Med. 2013 Jan;41(1):41-8. doi: 10.1097/CCM.0b013e318267636e.

DOI:10.1097/CCM.0b013e318267636e

PMID:23222263

Abstract

OBJECTIVE

Risk adjustment is essential in evaluating the performance of an ICU; however, assigning scores is time-consuming. We sought to create an automated ICU risk adjustment score, based on the Simplified Acute Physiology Score 3, using only data available within the electronic medical record (Kaiser Permanente HealthConnect).

DESIGN, SETTING, AND PATIENTS: The eSimplified Acute Physiology Score 3 was developed by adapting Kaiser Permanente HealthConnect structured data to Simplified Acute Physiology Score 3 criteria. The model was tested among 67,889 first-time ICU admissions at 21 hospitals between 2007 and 2011 to predict hospital mortality. Model performance was evaluated using published Simplified Acute Physiology Score 3 global and North American coefficients; a first-level customized version of the eSimplified Acute Physiology Score 3 was also developed in a 40% derivation cohort and tested in a 60% validation cohort.

MEASUREMENTS

Electronic variables were considered "directly" available if they could be mapped exactly within Kaiser Permanente HealthConnect; they were considered "adapted" if no exact electronic corollary was identified. Model discrimination was evaluated with area under receiver operating characteristic curves; calibration was assessed using Hosmer-Lemeshow goodness-of-fit tests.

MAIN RESULTS

Mean age at ICU admission was 65 ± 17 yrs. Mortality in the ICU was 6.2%; total in-hospital mortality was 11.2%. The majority of Simplified Acute Physiology Score 3 variables were considered "directly" available; others required adaptation based on diagnosis coding, medication records, or procedure tables. Mean eSimplified Acute Physiology Score 3 scores were 45 ± 13. Using published Simplified Acute Physiology Score 3 global and North American coefficients, the eSimplified Acute Physiology Score 3 demonstrated good discrimination (area under the receiver operating characteristic curve, 0.80-0.81); however, it overpredicted mortality. The customized eSimplified Acute Physiology Score 3 score demonstrated good discrimination (area under the receiver operating characteristic curve, 0.82) and calibration (Hosmer-Lemeshow goodness-of-fit chi-square p = 0.57) in the validation cohort. The eSimplified Acute Physiology Score 3 demonstrated stable performance when cohorts were limited to specific hospitals and years.

CONCLUSIONS

The customized eSimplified Acute Physiology Score 3 shows good potential for providing automated risk adjustment in the intensive care unit.

摘要

目的

在评估 ICU 绩效时，风险调整至关重要；但是，评分过程非常耗时。我们试图基于仅在电子病历（凯撒永久健康连接）中可用的数据，创建一个基于简化急性生理学评分 3 的自动 ICU 风险调整评分。

设计、设置和患者：eSimplified Acute Physiology Score 3 通过将 Kaiser Permanente HealthConnect 结构化数据改编为简化急性生理学评分 3 标准而开发。该模型在 2007 年至 2011 年间 21 家医院的 67889 例首次 ICU 入院患者中进行了测试，以预测医院死亡率。使用已发表的简化急性生理学评分 3 全球和北美系数评估模型性能；还在 40%的推导队列中开发了第一级定制版 eSimplified Acute Physiology Score 3，并在 60%的验证队列中进行了测试。

测量

如果可以在 Kaiser Permanente HealthConnect 中精确映射电子变量，则认为其“直接”可用；如果没有确定的电子对应项，则认为其“适应”。使用接收器操作特征曲线下的面积评估模型区分度；使用 Hosmer-Lemeshow 拟合优度检验评估校准。

主要结果

入住 ICU 时的平均年龄为 65 ± 17 岁。ICU 死亡率为 6.2%；总住院死亡率为 11.2%。简化急性生理学评分 3 的大多数变量被认为“直接”可用；其他变量需要根据诊断编码、药物记录或手术表进行改编。eSimplified Acute Physiology Score 3 的平均得分为 45 ± 13。使用已发表的简化急性生理学评分 3 全球和北美系数，eSimplified Acute Physiology Score 3 显示出良好的区分度（接收器操作特征曲线下的面积为 0.80-0.81）；然而，它高估了死亡率。定制版 eSimplified Acute Physiology Score 3 在验证队列中表现出良好的区分度（接收器操作特征曲线下的面积为 0.82）和校准（Hosmer-Lemeshow 拟合优度卡方 p = 0.57）。当将队列限制为特定医院和年份时，eSimplified Acute Physiology Score 3 表现出稳定的性能。