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5至90天死亡率预测器能否在时间和人群之间保持一致的表现?
Jonathan Handler1,2, Olivia J Lee3, Sheena Chatrath3
1Clinical Intelligence and Advanced Data Lab, OSF Healthcare System, 1306 N Berkeley Ave, Peoria, IL, 61603, USA. jonathan.a.handler@osfhealthcare.org.
Journal of medical systems
|July 3, 2023
概括
一个新的死亡率预测工具显示了不同群体的公平表现,有助于提前护理计划 (ACP) 讨论. 这种死亡率预测模型始终识别需要ACP的患者,无论人口统计数据或COVID-19大流行.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 医疗信息学 医疗信息学
- 老年学是一门学科.
背景情况:
- 预先护理计划 (ACP) 对于终身护理至关重要,但许多患者没有它就会死亡.
- 准确的死亡率预测可以促使ACP及时讨论.
- 预测器的性能可以在不同的人群中变化,并随着时间的推移而降低 (概念漂移).
研究的目的:
- 评估一个新的5至90天死亡率预测器的绩效公平性和一致性.
- 评估不同的人口,地理和时间框架的预测因素,包括COVID-19大流行前和期间.
- 确定预测因素是否可以支持公平的预先护理规划.
主要方法:
- 使用了 76,812 个成年住院患者遭遇的回顾性数据集.
- 预测是为入院的第一天生成的.
- 性能指标 (AUC-PR,回忆,精度) 在各个子组和时间段 (2018年与2021年) 中进行了分析.
主要成果:
- 整体AUC-PR在COVID-19之前和期间保持稳定,为29%.
- 在经过测试的确定性截止点上,回忆和精度显示了COVID前和COVID-19期间之间的最小变化.
- 虽然一些子组显示出小的性能差异,但在12.5%的截止值的精度在大多数人口统计学中基本上是公平的,无论疫情如何.
结论:
- 新型死亡率预测器在各种亚种群和时间框架中显示出一致和公平的表现.
- 这种工具可以通过公平地识别有风险的患者,可靠地支持预先护理计划 (ACP).
- 死亡率预测可以是一个有价值的,一致的,公平的方法来鼓励ACP对话.
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