TY - JOUR
T1 - Admission Laboratory Results to Enhance Prediction Models of Postdischarge Outcomes in Cardiac Care
AU - Pine, Michael
AU - Fry, Donald E.
AU - Hannan, Edward L.
AU - Naessens, James M.
AU - Whitman, Kay
AU - Reband, Agnes
AU - Qian, Feng
AU - Schindler, Joseph
AU - Sonneborn, Mark
AU - Roland, Jaclyn
AU - Hyde, Linda
AU - Dennison, Barbara A.
N1 - Publisher Copyright:
© 2016, © The Author(s) 2016.
PY - 2017/3/1
Y1 - 2017/3/1
N2 - Predictive modeling for postdischarge outcomes of inpatient care has been suboptimal. This study evaluated whether admission numerical laboratory data added to administrative models from New York and Minnesota hospitals would enhance the prediction accuracy for 90-day postdischarge deaths without readmission (PD-90) and 90-day readmissions (RA-90) following inpatient care for cardiac patients. Risk-adjustment models for the prediction of PD-90 and RA-90 were designed for acute myocardial infarction, percutaneous cardiac intervention, coronary artery bypass grafting, and congestive heart failure. Models were derived from hospital claims data and were then enhanced with admission laboratory predictive results. Case-level discrimination, goodness of fit, and calibration were used to compare administrative models (ADM) and laboratory predictive models (LAB). LAB models for the prediction of PD-90 were modestly enhanced over ADM, but negligible benefit was seen for RA-90. A consistent predictor of PD-90 and RA-90 was prolonged length of stay outliers from the index hospitalization.
AB - Predictive modeling for postdischarge outcomes of inpatient care has been suboptimal. This study evaluated whether admission numerical laboratory data added to administrative models from New York and Minnesota hospitals would enhance the prediction accuracy for 90-day postdischarge deaths without readmission (PD-90) and 90-day readmissions (RA-90) following inpatient care for cardiac patients. Risk-adjustment models for the prediction of PD-90 and RA-90 were designed for acute myocardial infarction, percutaneous cardiac intervention, coronary artery bypass grafting, and congestive heart failure. Models were derived from hospital claims data and were then enhanced with admission laboratory predictive results. Case-level discrimination, goodness of fit, and calibration were used to compare administrative models (ADM) and laboratory predictive models (LAB). LAB models for the prediction of PD-90 were modestly enhanced over ADM, but negligible benefit was seen for RA-90. A consistent predictor of PD-90 and RA-90 was prolonged length of stay outliers from the index hospitalization.
KW - cardiovascular disease
KW - clinically enhanced claims data
KW - postdischarge patient outcomes
KW - quality of care/patient safety (measurement)
KW - risk adjustment
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U2 - 10.1177/1062860615626279
DO - 10.1177/1062860615626279
M3 - Article
C2 - 26911665
AN - SCOPUS:85015056667
SN - 1062-8606
VL - 32
SP - 163
EP - 171
JO - American Journal of Medical Quality
JF - American Journal of Medical Quality
IS - 2
ER -