Predicting the risk of 1-year mortality in incident dialysis patients: accounting for case-mix severity in studies using administrative data.

Abstract:

BACKGROUND:Administrative databases are increasingly being used to study the incident dialysis population and have important advantages. However, traditional methods of risk adjustment have limitations in this patient population. OBJECTIVE:Our objective was to develop a prognostic index for 1-year mortality in incident dialysis patients using administrative data that was applicable to ambulatory patients, used objective definitions of candidate predictor variables, and was easily replicated in other environments. RESEARCH DESIGN:Anonymized, administrative health data housed at the Institute for Clinical Evaluative Sciences in Toronto, Canada were used to identify a population-based sample of 16,205 patients who initiated dialysis between July 1, 1998 and March 31, 2005. The cohort was divided into derivation, validation, and testing samples and 4 different strategies were used to derive candidate logistic regression models for 1-year mortality. The final risk prediction model was selected based on discriminatory ability (as measured by the c-statistic) and a risk prediction score was derived using methods adopted from the Framingham Heart Study. Calibration of the predictive model was assessed graphically. RESULTS:The risk of death during the first year of dialysis therapy was 16.4% in the derivation sample. The final model had a c-statistic of 0.765, 0.763, and 0.756 in the derivation, validation, and testing samples, respectively. Plots of actual versus predicted risk of death at 1-year showed good calibration. CONCLUSION:The prognostic index and summary risk score accurately predict 1-year mortality in incident dialysis patients and can be used for the purposes of risk adjustment.

journal_name

Med Care

journal_title

Medical care

authors

Quinn RR,Laupacis A,Hux JE,Oliver MJ,Austin PC

doi

10.1097/MLR.0b013e318202aa0b

subject

Has Abstract

pub_date

2011-03-01 00:00:00

pages

257-66

issue

3

eissn

0025-7079

issn

1537-1948

journal_volume

49

pub_type

杂志文章
  • Assessing the Effectiveness of Complex Interventions to Meet the Needs of VA Stakeholders: Experience of the Department of Veterans Affairs Evidence Synthesis Program.

    abstract:BACKGROUND:Complex health care interventions involve multiple distinct elements that contribute to their functioning. Conducting systematic reviews of complex interventions has substantial challenges. Although methodological guidance exists, less is known about the practical strategies and approaches undertaken by syst...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0000000000001158

    authors: Wilt TJ,Greer N,Duan-Porter W

    更新日期:2019-10-01 00:00:00

  • The future of kidney transplantation. The effect of improvements in survival rate on the shortage of donated kidneys.

    abstract::New drugs and other medical advances in organ transplantation are expected to increase the rate of retention of transplanted kidneys, or grafts, and therefore also raise patient survival rates. In particular, the immunosuppressive drug cyclosporine has been found to reduce the likelihood of rejection of a transplanted...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:

    authors: Ruth RJ,Wyszewianski L,Campbell DA

    更新日期:1987-03-01 00:00:00

  • HIV testing of asymptomatic patients in U.S. hospitals.

    abstract::The human immunodeficiency virus (HIV) epidemic and the prevalence of HIV-positive persons in the population has provoked marked anxiety among hospital staffs of acquiring nosocomially transmitted HIV infections. A national telephone survey of key staff in a sample of 561 acute-care hospitals was undertaken to describ...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-199102000-00001

    authors: Freeman HE

    更新日期:1991-02-01 00:00:00

  • Evaluation of index and profile measures of health status in a randomized controlled trial. Comparison of the Medical Outcomes Study 36-Item Short Form Health Survey, EuroQol, and disease specific measures.

    abstract:OBJECTIVES:The authors compare two generic measures of health status with disease-specific measures in a randomized controlled trial of transurethral resection of the prostate with laser vaporization prostatectomy for benign prostatic hypertrophy. METHODS:Patients entered into the trial completed the following questio...

    journal_title:Medical care

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1097/00005650-199711000-00003

    authors: Jenkinson C,Gray A,Doll H,Lawrence K,Keoghane S,Layte R

    更新日期:1997-11-01 00:00:00

  • Mobile health services: a study in cost-effectiveness.

    abstract::The techniques of cost-effectiveness are employed to simplify resource allocation decisions concerned with the use of land and air transport systems in the health services of a developing country. Outcome classifications are produced for patients seen by mobile and fixed primary care units. The mobile services examine...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-197704000-00001

    authors: Walker G,Gish O

    更新日期:1977-04-01 00:00:00

  • Comparison of two VA laboratory data repositories indicates that missing data vary despite originating from the same source.

    abstract:BACKGROUND:Assessing accuracy and completeness of data is an important component of conducting research. VA Healthcare System benefits from a highly developed electronic medical information system. The Immunology Case Registry was designed to monitor costs and quality of HIV care. The Decision Support System was develo...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0b013e31817d69c2

    authors: McGinnis KA,Skanderson M,Levin FL,Brandt C,Erdos J,Justice AC

    更新日期:2009-01-01 00:00:00

  • Travel time and attrition from VHA care among women veterans: how far is too far?

    abstract:BACKGROUND:Travel time, an access barrier, may contribute to attrition of women veterans from Veterans Health Administration (VHA) care. OBJECTIVE:We examined whether travel time influences attrition: (a) among women veterans overall, (b) among new versus established patients, and (c) among rural versus urban patients...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0000000000000296

    authors: Friedman SA,Frayne SM,Berg E,Hamilton AB,Washington DL,Saechao F,Maisel NC,Lin JY,Hoggatt KJ,Phibbs CS

    更新日期:2015-04-01 00:00:00

  • Benchmarking Veterans Affairs Medical Centers in the delivery of preventive health services: comparison of methods.

    abstract:OBJECTIVE:To identify consistent provision of clinical preventive services, we sought to benchmark all acute care Veterans Affairs Medical Centers (VAMCs) against each other nationally on the basis of multiple evidence-based, performance measures to identify facilities performing consistently higher and lower than expe...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-200206000-00011

    authors: Doebbeling BN,Vaughn TE,Woolson RF,Peloso PM,Ward MM,Letuchy E,BootsMiller BJ,Tripp-Reimer T,Branch LG

    更新日期:2002-06-01 00:00:00

  • Factors associated with the time nurses spend at the bedsides of seriously ill patients with poor prognoses.

    abstract:BACKGROUND:Little is known about the time health professionals spend with inpatients that are close to the end of life. SUBJECTS AND METHODS:We asked day-shift nurses to use a standardized log sheet to record how much time they spent in various categories of activity for 146 seriously ill medical inpatients with poor ...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/01.MLR.0000053226.38288.18

    authors: Sulmasy DP,Sood JR

    更新日期:2003-04-01 00:00:00

  • Development of an instrument to measure job satisfaction among dentists.

    abstract::Because of the rapid changes that have occurred in the dental profession, the Dentist Satisfaction Survey (DSS) was developed to assess both facet and overall job satisfaction among dentists. The DSS was administered to a sample of 558 California general dentists. The results suggest that the DSS is a practical, relia...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-199108000-00006

    authors: Shugars DA,Hays RD,DiMatteo MR,Cretin S

    更新日期:1991-08-01 00:00:00

  • Electronic Health Record Data Versus the National Health and Nutrition Examination Survey (NHANES): A Comparison of Overweight and Obesity Rates.

    abstract:BACKGROUND:Estimating population-level obesity rates is important for informing policy and targeting treatment. The current gold standard for obesity measurement in the United States-the National Health and Nutrition Examination Survey (NHANES)-samples <0.1% of the population and does not target state-level or health s...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0000000000000693

    authors: Funk LM,Shan Y,Voils CI,Kloke J,Hanrahan LP

    更新日期:2017-06-01 00:00:00

  • Physicians' assessments of their ability to provide high-quality care in a changing health care system.

    abstract:BACKGROUND:With the growth of managed care, there are increasing concerns but inconclusive evidence regarding deterioration in the quality of medical care. OBJECTIVES:To assess physicians' perceptions of their ability to provide high-quality care and explore what factors, including managed care, affect these perceptio...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-200103000-00006

    authors: Reschovsky J,Reed M,Blumenthal D,Landon B

    更新日期:2001-03-01 00:00:00

  • Quality Enhancement Research Initiative in ischemic heart disease: a quality initiative from the Department of Veterans Affairs. QUERI IHD Executive Committee.

    abstract::Despite the dramatic fall in ischemic heart disease (IHD) mortality rates over the last 3 decades, it remains the number one cause of death in the United States, and one of the most frequent indications for care by the US Department of Veterans Affairs. National practice guidelines have been developed and disseminated...

    journal_title:Medical care

    pub_type: 杂志文章,评审

    doi:

    authors: Every NR,Fihn SD,Sales AE,Keane A,Ritchie JR

    更新日期:2000-06-01 00:00:00

  • Why consider patients' preferences? A discourse analysis of clinical practice guideline developers.

    abstract:BACKGROUND:Several organizations are advocating for patients' preferences to be considered in clinical practice guideline development and implementation. However, lack of agreement on the goal and meaning of this policy curtails evaluation and development of patient involvement programs. GOAL:To describe guideline dev...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0b013e3181a81158

    authors: Boivin A,Green J,van der Meulen J,Légaré F,Nolte E

    更新日期:2009-08-01 00:00:00

  • The quality of cost data. A caution from the Department of Veterans Affairs experience.

    abstract::Many health care system, including that of the Department of Veterans Affairs (VA), are facing dramatic changes as they adapt to state-level reform legislation and move into managed care environments. As new costing systems are designed and as researchers seek to conduct cost-effectiveness studies to guide health poli...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-199603001-00008

    authors: Swindle RW Jr,Beattie MC,Barnett PG

    更新日期:1996-03-01 00:00:00

  • Patients Negatively Impacted by Discontinuity of Nursing Care During Acute Hospitalization.

    abstract:BACKGROUND:Continuity of nursing care in hospitals remains poor and not prioritized, and we do not know whether discontinuous nursing care is negatively impacting patient outcomes. OBJECTIVES:This study aims to examine nursing care discontinuity and its effect on patient clinical condition over the course of acute hos...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0000000000000670

    authors: Yakusheva O,Costa DK,Weiss M

    更新日期:2017-04-01 00:00:00

  • Effect of standardized, patient-centered label instructions to improve comprehension of prescription drug use.

    abstract:OBJECTIVE:To evaluate the effectiveness of standardized, patient-centered label (PCL) instructions to improve comprehension of prescription drug use compared with typical instructions. METHODS:A total of 500 adult patients recruited from 2 academic and 2 community primary care clinics in Chicago, IL and Shreveport, LA...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0b013e3181f38174

    authors: Wolf MS,Davis TC,Curtis LM,Webb JA,Bailey SC,Shrank WH,Lindquist L,Ruo B,Bocchini MV,Parker RM,Wood AJ

    更新日期:2011-01-01 00:00:00

  • The lifetime cost of current human immunodeficiency virus care in the United States.

    abstract:OBJECTIVE:We sought to project the lifetime cost of medical care for human immunodefiency virus (HIV)-infected adults using current antiretroviral therapy (ART) standards. METHODS:Medical visits and hospitalizations for any reason were from the HIV Research Network, a consortium of high-volume HIV primary care sites. ...

    journal_title:Medical care

    pub_type: 杂志文章,评审

    doi:10.1097/01.mlr.0000228021.89490.2a

    authors: Schackman BR,Gebo KA,Walensky RP,Losina E,Muccio T,Sax PE,Weinstein MC,Seage GR 3rd,Moore RD,Freedberg KA

    更新日期:2006-11-01 00:00:00

  • The planning and organization of a regionalized burn care system.

    abstract::The burn problem in the United States, as reflected in published data, is serious. More than 2,000,000 people are injured in burn accidents each year; 70,000 are hospitalized, involving approximately 9,000,000 disability days; and an estimated 9,000 die from their injuries. In 1964, the National Burn Information Excha...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-198002000-00006

    authors: Praiss IL,Feller I,James MH

    更新日期:1980-02-01 00:00:00

  • Use of illness-related ambulatory physician services in Finland.

    abstract::The total utilization rate of ambulatory illness-related physician services in Finland is higher in big urban health center areas than in rural areas. When only the health center physician utilization rates were studied the finding was opposite. A notable finding related to the impact of the national health planning w...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-198208000-00004

    authors: Kekki P

    更新日期:1982-08-01 00:00:00

  • Ascertainment of Testosterone Prescribing Practices in the VA.

    abstract:BACKGROUND:Prescribing of exogenous testosterone is increasing. Because of the risks associated with testosterone, it is important to follow evidence-based procedures when initiating therapy. OBJECTIVE:We evaluated whether dispensing of testosterone was preceded by appropriate ascertainment of androgen deficiency, and...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0000000000000398

    authors: Jasuja GK,Bhasin S,Reisman JI,Berlowitz DR,Rose AJ

    更新日期:2015-09-01 00:00:00

  • Overuse and systems of care: a systematic review.

    abstract:BACKGROUND:Current health care reform efforts are focused on reorganizing health care systems to reduce waste in the US health care system. OBJECTIVE:To compare rates of overuse in different health care systems and examine whether certain systems of care or insurers have lower rates of overuse of health care services....

    journal_title:Medical care

    pub_type: 杂志文章,评审

    doi:10.1097/MLR.0b013e31828dbafe

    authors: Keyhani S,Falk R,Howell EA,Bishop T,Korenstein D

    更新日期:2013-06-01 00:00:00

  • Use of traditional Indian medicine among urban native Americans.

    abstract::The purpose of this paper is to provide a systematic explanation of the use of traditional medicine among the native American population living in the San Francisco Bay area. Several hypotheses concerning the factors associated with this behavior are tested. These include tribal grouping, socioeconomic and sociocultur...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-197511000-00004

    authors: Fuchs M,Bashshur R

    更新日期:1975-11-01 00:00:00

  • Medication error in the care of HIV/AIDS patients: electronic surveillance, confirmation, and adverse events.

    abstract:BACKGROUND:Medication error occurring during the care of HIV-infected patients may lead to treatment failure, drug toxicity, or even death. OBJECTIVE:The objective of this study was to ascertain and confirm 5 categories of medication error in the care of HIV-infected patients. RESEARCH DESIGN:This study was a retrosp...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/01.mlr.0000175622.81335.4d

    authors: DeLorenze GN,Follansbee SF,Nguyen DP,Klein DB,Horberg M,Quesenberry CP Jr,Blick NT,Tsai AL

    更新日期:2005-09-01 00:00:00

  • Influencing behavior of physicians ordering laboratory tests: a literature study.

    abstract::There are various reasons why physicians order laboratory tests. Earlier studies have shown that in many cases test-ordering behavior lacks efficiency, resulting in excessive laboratory utilization. Throughout the years various attempts have been made to improve this situation. This review, based on the literature of ...

    journal_title:Medical care

    pub_type: 杂志文章,评审

    doi:10.1097/00005650-199309000-00003

    authors: Axt-Adam P,van der Wouden JC,van der Does E

    更新日期:1993-09-01 00:00:00

  • The role of public insurance and the public delivery system in improving birth outcomes for low-income pregnant women.

    abstract:BACKGROUND:Insurance expansions and service delivery system expansions are alternative policy instruments used to try to improve birth outcomes for low-income women. OBJECTIVES:The objective of this research is to investigate the effect of expansions of public insurance on access and birth outcomes for pregnant women ...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-200211000-00006

    authors: Susan Marquis M,Long SH

    更新日期:2002-11-01 00:00:00

  • Consumer Use of Provider Quality Report Cards: The Role of Dissemination and Media Coverage.

    abstract:OBJECTIVE:The objective of this study was to measure the dissemination of comparative provider quality information (CPQI) and evaluate its impact on consumers' awareness and use of CPQI. DATA SOURCES:Two-period, random-digit-dial panel survey of chronically ill consumers residing in 14 regions of the United States; su...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0000000000001279

    authors: Bhandari N,Scanlon DP,Shi Y,Smith RA

    更新日期:2020-04-01 00:00:00

  • A time-insensitive predictive instrument for acute hospital mortality due to congestive heart failure: development, testing, and use for comparing hospitals: a multicenter study.

    abstract::The purpose of this study was to develop a "time-insensitive" predictive instrument (TIPI) for acute hospital mortality due to congestive heart failure. In Phase 1, based on prospectively collected data on 401 congestive heart failure patients among 5,773 study patients who presented to six New England hospitals over ...

    journal_title:Medical care

    pub_type: 杂志文章,多中心研究

    doi:10.1097/00005650-199410000-00005

    authors: Selker HP,Griffith JL,D'Agostino RB

    更新日期:1994-10-01 00:00:00

  • Pharmacy-and diagnosis-based risk adjustment for children with Medicaid.

    abstract:BACKGROUND:Risk adjustment is useful for adjusting health care payments based on patients' health status. OBJECTIVE:This work seeks to examine how well pharmacy- and diagnosis-based risk adjusters predict child health expenditures in Medicaid populations. RESEARCH DESIGN:We used 1994-1995 Medicaid claims files for al...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/01.mlr.0000182551.87591.73

    authors: Kuhlthau K,Ferris TG,Davis RB,Perrin JM,Iezzoni LI

    更新日期:2005-11-01 00:00:00

  • Changes in thiazolidinedione use and outcomes following removal of a prior-authorization policy: controlled time-series analysis.

    abstract:OBJECTIVE:The aim of this study was to assess the impact of removing prior-authorization restrictions on the use of thiazolidinediones (TZDs) and outcomes. METHODS:In a controlled interrupted time-series analysis, whereby new users of antidiabetic agents over 65 years of age in adjacent Canadian provinces with differe...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0000000000000006

    authors: Gamble JM,Majumdar SR,Johnson JA,McAlister FA,Simpson SH,Eurich DT

    更新日期:2014-01-01 00:00:00