Using highly detailed administrative data to predict pneumonia mortality.
BACKGROUND:Mortality prediction models generally require clinical data or are derived from information coded at discharge, limiting adjustment for presenting severity of illness in observational studies using administrative data. OBJECTIVES:To develop and validate a mortality prediction model using...
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doaj-cd43fbae41e84eebb5b08cbc21f097282020-11-25T02:33:21ZengPublic Library of Science (PLoS)PLoS ONE1932-62032014-01-0191e8738210.1371/journal.pone.0087382Using highly detailed administrative data to predict pneumonia mortality.Michael B RothbergPenelope S PekowAruna PriyaMarya D ZilberbergRaquel BelfortiDaniel SkiestTara LaguThomas L HigginsPeter K LindenauerBACKGROUND:Mortality prediction models generally require clinical data or are derived from information coded at discharge, limiting adjustment for presenting severity of illness in observational studies using administrative data. OBJECTIVES:To develop and validate a mortality prediction model using administrative data available in the first 2 hospital days. RESEARCH DESIGN:After dividing the dataset into derivation and validation sets, we created a hierarchical generalized linear mortality model that included patient demographics, comorbidities, medications, therapies, and diagnostic tests administered in the first 2 hospital days. We then applied the model to the validation set. SUBJECTS:Patients aged ≥ 18 years admitted with pneumonia between July 2007 and June 2010 to 347 hospitals in Premier, Inc.'s Perspective database. MEASURES:In hospital mortality. RESULTS:The derivation cohort included 200,870 patients and the validation cohort had 50,037. Mortality was 7.2%. In the multivariable model, 3 demographic factors, 25 comorbidities, 41 medications, 7 diagnostic tests, and 9 treatments were associated with mortality. Factors that were most strongly associated with mortality included receipt of vasopressors, non-invasive ventilation, and bicarbonate. The model had a c-statistic of 0.85 in both cohorts. In the validation cohort, deciles of predicted risk ranged from 0.3% to 34.3% with observed risk over the same deciles from 0.1% to 33.7%. CONCLUSIONS:A mortality model based on detailed administrative data available in the first 2 hospital days had good discrimination and calibration. The model compares favorably to clinically based prediction models and may be useful in observational studies when clinical data are not available.http://europepmc.org/articles/PMC3909106?pdf=render |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Michael B Rothberg Penelope S Pekow Aruna Priya Marya D Zilberberg Raquel Belforti Daniel Skiest Tara Lagu Thomas L Higgins Peter K Lindenauer |
spellingShingle |
Michael B Rothberg Penelope S Pekow Aruna Priya Marya D Zilberberg Raquel Belforti Daniel Skiest Tara Lagu Thomas L Higgins Peter K Lindenauer Using highly detailed administrative data to predict pneumonia mortality. PLoS ONE |
author_facet |
Michael B Rothberg Penelope S Pekow Aruna Priya Marya D Zilberberg Raquel Belforti Daniel Skiest Tara Lagu Thomas L Higgins Peter K Lindenauer |
author_sort |
Michael B Rothberg |
title |
Using highly detailed administrative data to predict pneumonia mortality. |
title_short |
Using highly detailed administrative data to predict pneumonia mortality. |
title_full |
Using highly detailed administrative data to predict pneumonia mortality. |
title_fullStr |
Using highly detailed administrative data to predict pneumonia mortality. |
title_full_unstemmed |
Using highly detailed administrative data to predict pneumonia mortality. |
title_sort |
using highly detailed administrative data to predict pneumonia mortality. |
publisher |
Public Library of Science (PLoS) |
series |
PLoS ONE |
issn |
1932-6203 |
publishDate |
2014-01-01 |
description |
BACKGROUND:Mortality prediction models generally require clinical data or are derived from information coded at discharge, limiting adjustment for presenting severity of illness in observational studies using administrative data. OBJECTIVES:To develop and validate a mortality prediction model using administrative data available in the first 2 hospital days. RESEARCH DESIGN:After dividing the dataset into derivation and validation sets, we created a hierarchical generalized linear mortality model that included patient demographics, comorbidities, medications, therapies, and diagnostic tests administered in the first 2 hospital days. We then applied the model to the validation set. SUBJECTS:Patients aged ≥ 18 years admitted with pneumonia between July 2007 and June 2010 to 347 hospitals in Premier, Inc.'s Perspective database. MEASURES:In hospital mortality. RESULTS:The derivation cohort included 200,870 patients and the validation cohort had 50,037. Mortality was 7.2%. In the multivariable model, 3 demographic factors, 25 comorbidities, 41 medications, 7 diagnostic tests, and 9 treatments were associated with mortality. Factors that were most strongly associated with mortality included receipt of vasopressors, non-invasive ventilation, and bicarbonate. The model had a c-statistic of 0.85 in both cohorts. In the validation cohort, deciles of predicted risk ranged from 0.3% to 34.3% with observed risk over the same deciles from 0.1% to 33.7%. CONCLUSIONS:A mortality model based on detailed administrative data available in the first 2 hospital days had good discrimination and calibration. The model compares favorably to clinically based prediction models and may be useful in observational studies when clinical data are not available. |
url |
http://europepmc.org/articles/PMC3909106?pdf=render |
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