作为质量衡量的重症监护室 (ICU) 停留时间的建模:一个有问题的练习
John L Moran1, Graeme J Duke2, John D Santamaria3
1Department of Intensive Care Medicine, The Queen Elizabeth Hospital, Woodville, Australia. john.moran@adelaide.edu.au.
BMC medical research methodology
|September 14, 2023
概括
根据使用的统计模型,重症监护室 (ICU) 停留时间 (LOS) 的质量指标有很大差异. 对ICU绩效的排名不一致,应该谨慎地解释.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 生物统计学 生物统计学
- 关键护理医学 关键护理医学
背景情况:
- 住院时间 (LOS) 和风险调整后的 LOS (RALOS) 是已确立的质量指标.
- 现有的RALOS测量方法使用各种表述 (比率,差异,随机效应),缺乏比较分析.
研究的目的:
- 为了比较不同的统计模型和质量指标来评估ICU停留时间.
- 根据所选择的方法,评估ICU绩效排名的一致性.
主要方法:
- 利用了来自澳大利亚和新西兰重症监护协会 (ANZICS) CORE注册表的2016年数据.
- 开发了使用线性混合效应 (LMM) 和通用线性混合效应 (GLMM) 模型的LOS预测模型.
- 估计的质量指标包括RALOSR,OMELOS和特定站点的随机效应 (RE),可靠区间来自引导.
主要成果:
- 对125个ICU的94,361名患者的分析显示,模型预测 (LMM与GLMM) 或质量指标 (RALOSR,OMELOS,RE) 没有一致.
- 在不同医院分类 (大都市,私人,农村/区域,三级) 中,ICU排名不一致.
- 边缘和同时ICU排名信心集之间没有发现一致性.
结论:
- 对调整后的ICU LOS的统计推断高度依赖于所选择的估计器和质量指数.
- 没有单一的"最佳模型"来评估ICU的性能.
- 由于模型依赖性,从LOS指标获得的ICU绩效排名应谨慎处理.
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