Development of an iterative validation process for a 30-day hospital readmission prediction index
| Autor: | Raymond Yost, Joshua N. Raub, David Trupianio, Sean M McConachie |
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| Rok vydání: | 2019 |
| Předmět: |
Predictive validity
Adult Male medicine.medical_specialty Index (economics) Adolescent 030226 pharmacology & pharmacy Patient Readmission Risk Assessment 03 medical and health sciences Young Adult 0302 clinical medicine Discriminative model Risk Factors Positive predicative value Medicine Electronic Health Records Humans 030212 general & internal medicine Aged Retrospective Studies Pharmacology Aged 80 and over Receiver operating characteristic business.industry Health Policy Bayes Theorem Middle Aged Hospitals Patient admissions Emergency medicine Cohort Day hospital Female business |
| Zdroj: | American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists. 76(7) |
| ISSN: | 1535-2900 |
| Popis: | Purpose A study was conducted to determine if an iterative validation process could maintain or improve the discriminative and predictive capabilities of a 30-day hospital readmission prediction index over 2.5 years. Methods Patient admissions were retrospectively identified using the electronic medical record. The receiver operating characteristic curve was used to assess model discrimination. Prediction index specificity, sensitivity, and positive and negative predictive values were also assessed. A rolling iterative validation process was developed in which patient admissions were divided into 3-month cohorts. Each cohort was analyzed individually and then included into the cumulative patient cohort and analyzed again. Results From 121,277 patient visits, an iterative validation approach maintained the discrimination (0.71 to 0.72), predictive validity, and overall accuracy (80.9% to 81.7%) of the 30-day readmission prediction index over 2.5 years. Index sensitivity and negative predictive value increased from baseline while specificity and positive predictive value remained largely unchanged. None of the assessed index parameters diminished or became less useful over the course of the study. Conclusion An internal iterative validation process based on frequentist statistics maintained the discriminative ability and accuracy of a readmission index over 2.5 years despite numerous changes in the variables associated with readmission in the patient population. |
| Databáze: | OpenAIRE |
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