Developing and Validating a Pediatric Potentially Avoidable Transfer Quality Metric

This study aimed to evaluate a quality metric that identifies pediatric potentially avoidable transfers from diagnosis and procedure codes. Using physician medical record review as the gold standard, the following steps were used: (1) develop the initial metric definition, (2) estimate initial metric definition operating characteristics, (3) refine this definition to optimize the c-statistic, and (4) validate this optimized metric definition using a separate sample. The initial metric using Sample A patient transfers had a c-statistic of 0.63 (95% confidence interval = 0.53-0.73). Following 22 revisions, the optimized metric definition was a transfer discharged within 24 hours that did not receive any of a select list of 60 268 specialized diagnoses or procedures. The optimized metric on Sample B demonstrated a sensitivity of 80.6%, specificity of 85.7%, and c-statistic of 0.83 (95% confidence interval = 0.75-0.91). The quality metric developed and validated in this study demonstrated satisfactory operating characteristics, providing a feasible means to measure this important outcome.

A Commentary on Diversity Measures UniFrac in Very Small Sample Size

In phylogenetic, the diversity measures as UniFrac, weighted UniFrac, and normalized weighted UniFrac are used to estimate the closeness between two samples of genetic material sequences. These measures are widely used in microbiology to compare microbial communities. Furthermore, when the sample size is large enough, very good results have been obtained experimentally. However, some authors do not suggest using them when the sample size is very small. Recently, it has been mentioned that the weighted UniFrac measure can be seen as the Kantorovich-Rubinstein metric between the corresponding empirical distributions of samples of genetic material. Also, it is well known that the Kantorovich-Rubinstein metric complies the metric definition. However, one of the main reasons to establish it is that the sample size is large enough. The goal of this article is to prove that the diversity measures UniFrac are not metrics when the sample size is very small, which justifies why it must not be used in that case, but yes the Kantorovich-Rubinstein metric.