患者报告的数据可以改善关于谁将是不列颠哥伦比亚省高需要,高成本的患者的预测吗?
Logan Trenaman1,2, Daphne Guh3, Stirling Bryan4
1Department of Health Systems and Population Health, School of Public Health, University of Washington, 3980 15th Ave NE, Fourth Floor, Box 351621, Seattle, WA, 98195, USA. trenaman@uw.edu.
准确预测高需要,高成本 (HNHC) 患者至关重要. 患者报告的数据显著增强了预测模型,改善了对医疗保健成本最高的个体的识别.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 预测分析是一种预测分析.
- 卫生经济学 卫生经济学
背景情况:
- 识别高需要,高成本 (HNHC) 患者对于改善医疗保健结果和资源配置至关重要.
- 预测建模在积极识别风险人群方面发挥着关键作用.
- 目前的模型通常依赖于行政和临床数据,可能错过了有价值的患者视角.
研究的目的:
- 开发和评估预测模型,以识别有风险成为未来高需要,高成本 (HNHC) 患者的个人.
- 为了比较结合患者报告数据的模型与使用标准的人口,临床和资源利用数据的模型的预测性能.
主要方法:
- 利用来自加拿大不列颠哥伦比亚省的两个患者报告的调查数据集 (住院和急诊室),与行政数据联系起来.
- 将结果定义为在调查完成后的一年内成为HNHC患者 (占人口成本的前5%).
- 将标准预测器集与增强集进行比较,其中包括患者报告的数据,使用后勤回归,评估歧视 (c-统计,成本捕获) 和校准.
主要成果:
- 模型表现出良好的区分和校准.
- 纳入患者报告的数据改善了模型歧视,c统计数据的增加证明了这一点 (例如,在ED调查逻辑回归模型中从0.83增加到0.85).
- 改进的模型显示了更好的成本捕获,并在各种临床效用值中提供了最高的净收益.
结论:
- 患者报告的数据显著提高了设计用于预测高需要,高成本 (HNHC) 患者的模型的歧视性性能.
- 这些增强模型在识别医疗保健支出最高的患者方面特别有效.
- 将患者的见解纳入预测分析提供了一个有前途的途径,用于针对性的医疗保健干预.
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