title: Admission Laboratory Results to Enhance Prediction Models of Postdischarge Outcomes in Cardiac Care.
abstract: Predictive modeling for postdischarge outcomes of inpatient care has been suboptimal. This study evaluated whether admission numerical laboratory data added to administrative models from New York and Minnesota hospitals would enhance the prediction accuracy for 90-day postdischarge deaths without readmission (PD-90) and 90-day readmissions (RA-90) following inpatient care for cardiac patients. Risk-adjustment models for the prediction of PD-90 and RA-90 were designed for acute myocardial infarction, percutaneous cardiac intervention, coronary artery bypass grafting, and congestive heart failure. Models were derived from hospital claims data and were then enhanced with admission laboratory predictive results. Case-level discrimination, goodness of fit, and calibration were used to compare administrative models (ADM) and laboratory predictive models (LAB). LAB models for the prediction of PD-90 were modestly enhanced over ADM, but negligible benefit was seen for RA-90. A consistent predictor of PD-90 and RA-90 was prolonged length of stay outliers from the index hospitalization.
authors.affiliation: 1 MPA Healthcare Solutions, Inc., Chicago, IL.
authors.forename: Michael
authors.initials: M
authors.lastname: Pine
authors.affiliation: 1 MPA Healthcare Solutions, Inc., Chicago, IL.
authors.forename: Donald E
authors.initials: DE
authors.lastname: Fry
authors.affiliation: 2 University at Albany-State University of New York, Albany, NY.
authors.forename: Edward L
authors.initials: EL
authors.lastname: Hannan
authors.affiliation: 3 The Mayo Clinic, Rochester, MN.
authors.forename: James M
authors.initials: JM
authors.lastname: Naessens
authors.affiliation: 1 MPA Healthcare Solutions, Inc., Chicago, IL.
authors.forename: Kay
authors.initials: K
authors.lastname: Whitman
authors.affiliation: 1 MPA Healthcare Solutions, Inc., Chicago, IL.
authors.forename: Agnes
authors.initials: A
authors.lastname: Reband
authors.affiliation: 2 University at Albany-State University of New York, Albany, NY.
authors.forename: Feng
authors.initials: F
authors.lastname: Qian
authors.affiliation: 4 Minnesota Hospital Association, St Paul, MN.
authors.forename: Joseph
authors.initials: J
authors.lastname: Schindler
authors.affiliation: 4 Minnesota Hospital Association, St Paul, MN.
authors.forename: Mark
authors.initials: M
authors.lastname: Sonneborn
authors.affiliation: 4 Minnesota Hospital Association, St Paul, MN.
authors.forename: Jaclyn
authors.initials: J
authors.lastname: Roland
authors.affiliation: 1 MPA Healthcare Solutions, Inc., Chicago, IL.
authors.forename: Linda
authors.initials: L
authors.lastname: Hyde
authors.affiliation: 5 New York State Department of Health, Albany, NY.
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Dennison
mesh_terms: D000067575:Administrative Claims, Healthcare / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D001026:Coronary Artery Bypass / Q000401:mortality / Q000706:statistics & numerical data; D006331:Heart Diseases / Q000401:mortality / Q000473:pathology*; D006333:Heart Failure / Q000401:mortality / Q000473:pathology; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D015233:Models, Statistical; D009203:Myocardial Infarction / Q000401:mortality / Q000473:pathology; D010351:Patient Discharge / Q000706:statistics & numerical data; D062645:Percutaneous Coronary Intervention / Q000401:mortality / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D012307:Risk Factors; D016896:Treatment Outcome
keywords: cardiovascular disease; clinically enhanced claims data; postdischarge patient outcomes; quality of care/patient safety (measurement); risk adjustment