scholarly journals Predicting hospital mortality for intensive care unit patients: Time-series analysis

2019 ◽  
Vol 26 (2) ◽  
pp. 1043-1059 ◽  
Author(s):  
Aya Awad ◽  
Mohamed Bader-El-Den ◽  
James McNicholas ◽  
Jim Briggs ◽  
Yasser El-Sonbaty

Current mortality prediction models and scoring systems for intensive care unit patients are generally usable only after at least 24 or 48 h of admission, as some parameters are unclear at admission. However, some of the most relevant measurements are available shortly following admission. It is hypothesized that outcome prediction may be made using information available in the earliest phase of intensive care unit admission. This study aims to investigate how early hospital mortality can be predicted for intensive care unit patients. We conducted a thorough time-series analysis on the performance of different data mining methods during the first 48 h of intensive care unit admission. The results showed that the discrimination power of the machine-learning classification methods after 6 h of admission outperformed the main scoring systems used in intensive care medicine (Acute Physiology and Chronic Health Evaluation, Simplified Acute Physiology Score and Sequential Organ Failure Assessment) after 48 h of admission.

2019 ◽  
Vol 28 (6) ◽  
pp. 449-458 ◽  
Author(s):  
Steven C Chatfield ◽  
Frank M Volpicelli ◽  
Nicole M Adler ◽  
Kunhee Lucy Kim ◽  
Simon A Jones ◽  
...  

BackgroundReducing costs while increasing or maintaining quality is crucial to delivering high value care.ObjectiveTo assess the impact of a hospital value-based management programme on cost and quality.DesignTime series analysis of non-psychiatric, non-rehabilitation, non-newborn patients discharged between 1 September 2011 and 31 December 2017 from a US urban, academic medical centre.InterventionNYU Langone Health instituted an institution-wide programme in April 2014 to increase value of healthcare, defined as health outcomes achieved per dollar spent. Key features included joint clinical and operational leadership; granular and transparent cost accounting; dedicated project support staff; information technology support; and a departmental shared savings programme.MeasurementsChange in variable direct costs; secondary outcomes included changes in length of stay, readmission and in-hospital mortality.ResultsThe programme chartered 74 projects targeting opportunities in supply chain management (eg, surgical trays), operational efficiency (eg, discharge optimisation), care of outlier patients (eg, those at end of life) and resource utilisation (eg, blood management). The study cohort included 160 434 hospitalisations. Adjusted variable costs decreased 7.7% over the study period. Admissions with medical diagnosis related groups (DRG) declined an average 0.20% per month relative to baseline. Admissions with surgical DRGs had an early increase in costs of 2.7% followed by 0.37% decrease in costs per month. Mean expense per hospitalisation improved from 13% above median for teaching hospitals to 2% above median. Length of stay decreased by 0.25% per month relative to prior trends (95% CI −0.34 to 0.17): approximately half a day by the end of the study period. There were no significant changes in 30-day same-hospital readmission or in-hospital mortality. Estimated institutional savings after intervention costs were approximately $53.9 million.LimitationsObservational analysis.ConclusionA systematic programme to increase healthcare value by lowering the cost of care without compromising quality is achievable and sustainable over several years.


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