对30天儿科医院再接收风险预测模型的验证
Alison R Carroll1,2, Matthew Hall3, Mitch Harris3
1Division of Pediatric Hospital Medicine, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee.
JAMA network open
|February 13, 2025
概括
儿科再接收风险模型显示,随着时间的推移,准确性下降,医院的表现各不相同. 在临床使用之前,本地验证至关重要,以确保可靠的预测,避免可预防的医院再入院.
科学领域:
- 儿科医疗保健研究的研究.
- 临床信息学是一种临床信息学.
- 医疗服务研究 医疗服务研究
背景情况:
- 准确识别医院再接收风险有助于决策和有针对性的干预措施.
- 可预防的再接收对医疗保健系统构成重大负担.
研究的目的:
- 在多家医院验证儿童再接收风险预测模型.
- 评估这些模型对临床实施的概括性和可行性.
主要方法:
- 使用48家美国儿童医院的儿科健康信息系统 (PHIS) 数据库进行预后研究.
- 分析了2016-2019年三种不同儿科队列的数据:新入院模型 (NAM),最近入院模型 (RAM) 和幼婴模型 (YIM).
- 使用接收器运行特征曲线下面面积 (AUROC) 和校准图表的模型的时间和外部验证.
主要成果:
- 与原始估计相比,时间验证显示所有模型的歧视减少.
- 外部验证显示了类似的趋势,在各医院的表现中存在显著差异.
- 大多数医院的校准表现不佳,并高估或低估了再接收风险.
结论:
- 再接收风险预测模型显示,随着时间的推移,准确性降低,各机构的表现变化.
- 在将这些模型应用于临床实践之前,必须进行本地验证.
- 提高通用性可能需要多中心模型衍生和更广泛的预测器集.
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