دورية أكاديمية
Development and Validation of the Hospital Medicine Safety Sepsis Initiative Mortality Model.
| العنوان: | Development and Validation of the Hospital Medicine Safety Sepsis Initiative Mortality Model. |
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| المؤلفون: | Prescott HC; Department of Internal Medicine, University of Michigan, Ann Arbor, MI; VA Center for Clinical Management Research, Ann Arbor, MI. Electronic address: hprescot@med.umich.edu., Heath M; Department of Internal Medicine, University of Michigan, Ann Arbor, MI., Munroe ES; Department of Internal Medicine, University of Michigan, Ann Arbor, MI., Blamoun J; MyMichigan Health, Midland, MI., Bozyk P; Corewell Health, Royal Oak, MI., Hechtman RK; Department of Internal Medicine, University of Michigan, Ann Arbor, MI., Horowitz JK; Department of Internal Medicine, University of Michigan, Ann Arbor, MI., Jayaprakash N; Henry Ford Health, Detroit, MI., Kocher KE; Department of Emergency Medicine, University of Michigan, Ann Arbor, MI; VA Center for Clinical Management Research, Ann Arbor, MI., Younas M; Hurley Medical Center, Flint, MI., Taylor SP; Department of Internal Medicine, University of Michigan, Ann Arbor, MI., Posa PJ; Department of Internal Medicine, University of Michigan, Ann Arbor, MI., McLaughlin E; Department of Internal Medicine, University of Michigan, Ann Arbor, MI., Flanders SA; Department of Internal Medicine, University of Michigan, Ann Arbor, MI. |
| المصدر: | Chest [Chest] 2024 Jul 02. Date of Electronic Publication: 2024 Jul 02. |
| Publication Model: | Ahead of Print |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Elsevier Country of Publication: United States NLM ID: 0231335 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1931-3543 (Electronic) Linking ISSN: 00123692 NLM ISO Abbreviation: Chest Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: 2016- : New York : Elsevier Original Publication: Chicago : American College of Chest Physicians |
| مستخلص: | Background: When comparing outcomes after sepsis, it is essential to account for patient case mix to make fair comparisons. We developed a model to assess risk-adjusted 30-day mortality in the Michigan Hospital Medicine Safety sepsis initiative (HMS-Sepsis). Research Question: Can HMS-Sepsis registry data adequately predict risk of 30-day mortality? Do performance assessments using adjusted vs unadjusted data differ? Study Design and Methods: Retrospective cohort of community-onset sepsis hospitalizations in the HMS-Sepsis registry (April 2022-September 2023), with split-derivation (70%) and validation (30%) cohorts. We fit a risk-adjustment model (HMS-Sepsis mortality model) incorporating acute physiologic, demographic, and baseline health data and assessed model performance using concordance (C) statistics, Brier's scores, and comparisons of predicted vs observed mortality by deciles of risk. We compared hospital performance (first quintile, middle quintiles, fifth quintile) using observed vs adjusted mortality to understand the extent to which risk adjustment impacted hospital performance assessment. Results: Among 17,514 hospitalizations from 66 hospitals during the study period, 12,260 hospitalizations (70%) were used for model derivation and 5,254 hospitalizations (30%) were used for model validation. Thirty-day mortality for the total cohort was 19.4%. The final model included 13 physiologic variables, two physiologic interactions, and 16 demographic and chronic health variables. The most significant variables were age, metastatic solid tumor, temperature, altered mental status, and platelet count. The model C statistic was 0.82 for the derivation cohort, 0.81 for the validation cohort, and ≥ 0.78 for all subgroups assessed. Overall calibration error was 0.0%, and mean calibration error across deciles of risk was 1.5%. Standardized mortality ratios yielded different assessments than observed mortality for 33.9% of hospitals. Interpretation: The HMS-Sepsis mortality model showed strong discrimination and adequate calibration and reclassified one-third of hospitals to a different performance category from unadjusted mortality. Based on its strong performance, the HMS-Sepsis mortality model can aid in fair hospital benchmarking, assessment of temporal changes, and observational causal inference analysis. Competing Interests: Financial/Nonfinancial Disclosures The authors have reported to CHEST the following: H. C. P., M. H., J. K. H., P. J. P., E. M., and S. A. F.) receive salary support from BCBSM for work on HMS. K. K. has salary support from BSBSM for work on the Michigan Emergency Department Improvement Collaborative, an ED-based quality network. The authors report grant funding and salary support unrelated to this study from the National Institutes of Health (H. C. P., N. J., S. P. T.), the Agency for Healthcare Research and Quality (H. C. P., S. P. T.), Department of Veterans Affairs (H. C. P.), and Centers for Disease Control and Prevention (H. C. P., J. K. H.). H. C. P. and J. N. serve on the advisory board to Sepsis Alliance (unpaid). H. C. P. serves on the Surviving Sepsis Campaign guidelines. (Published by Elsevier Inc.) |
| معلومات مُعتمدة: | F32 HL172463 United States HL NHLBI NIH HHS; T32 HL007749 United States HL NHLBI NIH HHS |
| فهرسة مساهمة: | Keywords: benchmarking; health care quality indicator; hospitalization; risk adjustment |
| تواريخ الأحداث: | Date Created: 20240704 Latest Revision: 20240731 |
| رمز التحديث: | 20240731 |
| DOI: | 10.1016/j.chest.2024.06.3769 |
| PMID: | 38964673 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder | تدمد: | 1931-3543 |
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| DOI: | 10.1016/j.chest.2024.06.3769 |