Development and validation of a risk-adjustment tool in acute asthma.
OBJECTIVE
To develop and prospectively validate a risk-adjustment tool in acute asthma.


METHODS
Data were obtained from two large studies on acute asthma, the Multicenter Airway Research Collaboration (MARC) and the National Emergency Department Safety Study (NEDSS) cohorts. Both studies involved >60 emergency departments (EDs) and were performed during 1996-2001 and 2003-2006, respectively. Both included patients aged 18-54 years presenting to the ED with acute asthma.


METHODS
Retrospective cohort studies.


METHODS
Clinical information was obtained from medical record review. The risk index was derived in the MARC cohort and then was prospectively validated in the NEDSS cohort.


RESULTS
There were 3,515 patients in the derivation cohort and 3,986 in the validation cohort. The risk index included nine variables (age, sex, current smoker, ever admitted for asthma, ever intubated for asthma, duration of symptoms, respiratory rate, peak expiratory flow, and number of beta-agonist treatments) and showed satisfactory discrimination (area under the receiver operating characteristic curve, 0.75) and calibration ( p=.30 for Hosmer-Lemeshow test) when applied to the validation cohort.


CONCLUSIONS
We developed and validated a novel risk-adjustment tool in acute asthma. This tool can be used for health care provider profiling to identify outliers for quality improvement purposes.
Tsai
Chu-Lin
CL
EMNet Coordinating Center, Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, 02114, USA. cltsai@post.harvard.edu
Clark
Sunday
S
Sullivan
Ashley F
AF
Camargo
Carlos A
CA
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D001249:Asthma; D015331:Cohort Studies; D004363:Drug Utilization; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D020379:Risk Adjustment / Q000379:methods*; D012737:Sex Factors; D012907:Smoking; D055815:Young Adult
D018927:Anti-Asthmatic Agents