Using severity measures to predict the likelihood of death for pneumonia inpatients
Department of Quantitative Health Sciences
Medical Subject Headings
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
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.
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Citation: J Gen Intern Med. 1996 Jan;11(1):23-31. Link to article on publisher's site
Iezzoni, Lisa I.; Shwartz, Michael; Ash, Arlene S.; and Mackiernan, Yevgenia D., "Using severity measures to predict the likelihood of death for pneumonia inpatients" (1996). Quantitative Health Sciences Publications and Presentations. 644.