开发和验证预测模型，用于确定老年吸入性肺炎患者的出院去向。
Development and validation of prediction models for the discharge destination of elderly patients with aspiration pneumonia.
机构信息
Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Department of Health Policy and Informatics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
出版信息
PLoS One. 2023 Feb 24;18(2):e0282272. doi: 10.1371/journal.pone.0282272. eCollection 2023.
BACKGROUND
Discharge planning enhances the safe and timely transfer of inpatients between facilities. Predicting the discharge destination of inpatients with aspiration pneumonia is important for discharge planning. We aimed to develop and validate prediction models for the discharge destination of elderly patients with aspiration pneumonia.
METHODS
Using a nationwide inpatient database, we identified aspiration pneumonia cases for patients aged ≥65 years who had been admitted to hospital from their home or from a nursing home between April 2020 and March 2021. We divided the cases into derivation and validation cohorts according to the location of the admitting hospital. We developed two prediction models by dividing the cases based on the patient's place of residence prior to admission, one model to predict the home discharge of cases admitted from home and the other to predict the home or to a nursing home discharge of cases admitted from a nursing home. The models were internally validated with bootstrapping and internal-externally validated using a validation cohort. Nomograms that could be used easily in clinical practice were also created.
RESULTS
The derivation cohort included 19,746 cases admitted from home and 14,359 cases admitted from a nursing home. Of the former, 10,760 (54.5%) cases were discharged home; from the latter, 7,071 (49.2%) were discharged to either home or a nursing home. The validation cohort included 6,262 cases admitted from home and 6,352 cases admitted from a nursing home. In the internal-external validation, the C-statistics of the final model for the cases admitted from home and the cases admitted from a nursing home were 0.71 and 0.67, respectively.
CONCLUSIONS
We developed and validated new prediction models for the discharge of elderly patients with aspiration pneumonia either to home or to a nursing home. Our models and nomograms could facilitate the early implementation of discharge planning.
背景
出院计划可促进患者在医疗机构之间安全且及时地转移。预测吸入性肺炎患者的出院去向对于出院计划非常重要。我们旨在开发和验证预测老年吸入性肺炎患者出院去向的模型。
方法
我们使用全国性住院患者数据库，确定了年龄≥65 岁的患者的吸入性肺炎病例，这些患者在 2020 年 4 月至 2021 年 3 月期间从家中或疗养院入院。我们根据入院医院的位置将病例分为推导和验证队列。我们根据患者入院前的居住地将病例分为两组，一组模型用于预测从家中入院的患者的出院去向，另一组模型用于预测从疗养院入院的患者的出院去向（家中或疗养院）。我们使用 bootstrap 对模型进行内部验证，并使用验证队列进行内部-外部验证。我们还创建了易于在临床实践中使用的列线图。
结果
推导队列包括 19746 例从家中入院的病例和 14359 例从疗养院入院的病例。其中，10760 例（54.5%）患者出院回家；后者中，7071 例（49.2%）出院至家中或疗养院。验证队列包括 6262 例从家中入院的病例和 6352 例从疗养院入院的病例。在内部-外部验证中，从家中入院和从疗养院入院的最终模型的 C 统计量分别为 0.71 和 0.67。
结论
我们开发并验证了新的预测模型，用于预测老年吸入性肺炎患者出院去向（家中或疗养院）。我们的模型和列线图可以帮助提前实施出院计划。
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