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    Using severity measures to predict the likelihood of death for pneumonia inpatients

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    Authors
    Iezzoni, Lisa I.
    Shwartz, Michael
    Ash, Arlene S.
    Mackiernan, Yevgenia D.
    UMass Chan Affiliations
    Department of Quantitative Health Sciences
    Document Type
    Journal Article
    Publication Date
    1996-01-01
    Keywords
    Adolescent
    Adult
    Aged
    Aged, 80 and over
    Cohort Studies
    Female
    *Hospital Mortality
    Humans
    Logistic Models
    Male
    Middle Aged
    Outcome Assessment (Health Care)
    Pneumonia
    Probability
    Retrospective Studies
    *Severity of Illness Index
    Survival Rate
    United States
    Biostatistics
    Epidemiology
    Health Services Research
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    Link to Full Text
    http://dx.doi.org/10.1007/BF02603481
    Abstract
    OBJECTIVE: To see whether predictions of patients, likelihood of dying in-hospital differed among severity methods. DESIGN: Retrospective cohort. PATIENTS: 18,016 persons 18 years of age and older managed medically for pneumonia; 1,732 (9.6%) in-hospital deaths. METHODS: Probability of death was calculated for each patient using logistic regression with age, age squared, sex, and each of five severity measures as the independent variables: 1) admission MedisGroups probability of death scores; 2) scores based on 17 admission physiologic variables; 3) Disease Staging's probability of mortality model; the Severity Score of Patient Management Categories (PMCs); 4) and the All Patient Refined Diagnosis-Related Groups (APR-DRGs). Patients were ranked by calculated probability of death; 5) rankings were compared across severity methods. Frequencies of 14 clinical findings considered poor prognostic indicators in pneumonia were examined for patients ranked differently by different methods. RESULTS: MedisGroups and the physiology score predicted a similar likelihood of death for 89.2% of patients. In contrast, the three code-based severity methods rated over 25% of patients differently by predicted likelihood of death when compared with the rankings of the two clinical data-based methods [MedisGroups and the physiology score]. MedisGroups and the physiology score demonstrated better clinical credibility than the three severity methods based on discharge abstract data. CONCLUSIONS: Some pairs of severity measures ranked over 25% of patients very differently by predicted probability of death. Results of outcomes studies may vary depending on which severity method is used for risk adjustment.
    Source
    J Gen Intern Med. 1996 Jan;11(1):23-31. Link to article on publisher's site
    DOI
    10.1007/BF02603481
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/47509
    PubMed ID
    8691283
    Related Resources
    Link to Article in PubMed
    ae974a485f413a2113503eed53cd6c53
    10.1007/BF02603481
    Scopus Count
    Collections
    Population and Quantitative Health Sciences Publications

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