使用以公平为中心的方法开发产后医院使用预测模型
Teresa Janevic1, Lewis E Tomalin2, Kimberly B Glazer3
1Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY.
一个新的模型通过结合健康的社会和结构性决定因素来确定患产后住院高风险的个体. 这种方法显著减少了在分娩后护理获取方面的种族种族差异.
科学领域:
- 孕产妇健康 孕产妇健康
- 健康 公平 卫生 公平
- 预测建模预测建模
背景情况:
- 在孕产妇发病率和死亡率方面,种族不平等仍然存在,黑人和西班牙裔个人中产后医院使用率更高.
- 产后住院提供了一个关键的窗口,用于查高危人群,以防止产后不良结果.
- 现有的风险模型往往缺乏健康的社会/结构决定因素,并且可能因种族而偏见.
研究的目的:
- 为产后医院使用开发风险预测模型.
- 将健康的社会和结构决定因素纳入模型.
- 使用以股权为中心的风险分层方法.
主要方法:
- 使用链接出生证明和医院出院数据的回顾性队列研究 (纽约市,2016-2018).
- 定义"综合产后医院使用"是指在分娩后30天内在医院使用的任何医院使用.
- 利用统计和机器学习算法,包括集体方法,结合健康的社会和结构决定因素 (例如,极端度指数,儿童机会指数).
主要成果:
- 总体而言,产后医院使用率为5.7%,黑人 (8.8%) 和西班牙裔 (7.4%) 个体的比例更高.
- 开发了"综合产后医院使用"模型 (AUC 0.69) 和"因果特定的产后医院使用"模型 (AUC 0.75).
- "综合产后医院使用"模型,当与干预相结合时,表明种族种族差异的最大减少.
结论:
- 开发的"综合产后医院使用"预测模型有效地识别了有风险的个体.
- 纳入健康的社会和结构性决定因素对于公平的风险分层至关重要.
- 这种模式可以在分娩后使用,以改善产后护理的准入,并减少差异.
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