Dept. of Biomedical Informatics, Vanderbilt University, 2525 West End Ave. Suite 1475, Nashville, TN 37203, USA.
Dept. of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA.
J Biomed Inform. 2019 Mar;91:103111. doi: 10.1016/j.jbi.2019.103111. Epub 2019 Jan 30.
Administrators assess care variability through chart review or cost variability to inform care standardization efforts. Chart review is costly and cost variability is imprecise. This study explores the potential of physician orders as an alternative measure of care variability.
MATERIALS & METHODS: The authors constructed an order variability metric from adult Vanderbilt University Hospital patients treated between 2013 and 2016. The study compared how well a cost variability model predicts variability in the length of stay compared to an order variability model. Both models adjusted for covariates such as severity of illness, comorbidities, and hospital transfers.
The order variability model significantly minimized the Akaike information criterion (superior outcome) compared to the cost variability model. This result also held when excluding patients who received intensive care.
Order variability can potentially typify care variability better than cost variability. Order variability is a scalable metric, calculable during the course of care.
管理者通过图表审查或成本变化来评估护理变异性，以告知护理标准化工作。图表审查成本高，成本变化不精确。本研究探讨了将医嘱作为衡量护理变异性的替代指标的可能性。
作者构建了一个从 2013 年至 2016 年在范德比尔特大学医院接受治疗的成年患者中得出的医嘱变异性指标。该研究比较了成本变异性模型和医嘱变异性模型在预测住院时间变异性方面的表现。两种模型均调整了疾病严重程度、合并症和医院转院等协变量。
与成本变异性模型相比，医嘱变异性模型显著最小化了赤池信息量准则（更好的结果）。当排除接受重症监护的患者时，这一结果仍然成立。
医嘱变异性可能比成本变异性更能典型地描述护理变异性。医嘱变异性是一种可扩展的指标，可在护理过程中计算。
