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| Predicate | Object |
|---|---|
| rdf:type | |
| lifeskim:mentions | |
| pubmed:issue |
4
|
| pubmed:dateCreated |
1993-2-12
|
| pubmed:abstractText |
Mortality rates for very-low-birthweight infants vary significantly among different neonatal intensive care units (NICUs). Computational models and computer simulation are used to predict the performance of an algorithm for identifying individual NICUs within a network that have greater than 110% of the expected birthweight-adjusted mortality risk. The algorithm maintains high sensitivity and specificity with as few as three moderately heterogeneous risk categories when applied to large health care networks; the model parameters were based on preliminary data from a real NICU network. The performance of the algorithm depends on the number of admissions at the individual NICU. A NICU with a center-specific risk 130% of the network average would be correctly identified as an outlier 50% of the time if it had 35 admissions, 59% of the time if it had 70 admissions, and 77% of the time if it had 280 admissions. A NICU with average risk would be incorrectly identified as an outlier 16%, 12%, or 2% of the time if it had 35, 70, or 280 admissions, respectively. Severity-of-illness casemix adjustment did not improve these results. It is concluded that the sensitivity and specificity of the algorithm in determining which facilities have higher-than-expected mortality will be less in typical NICU networks than in large health care networks that treat adult patients. It is unlikely that severity-of-illness adjustments will overcome the problem of the small numbers of admissions at individual NICUs.
|
| pubmed:language |
eng
|
| pubmed:journal | |
| pubmed:citationSubset |
IM
|
| pubmed:status |
MEDLINE
|
| pubmed:issn |
0272-989X
|
| pubmed:author | |
| pubmed:issnType |
Print
|
| pubmed:volume |
12
|
| pubmed:owner |
NLM
|
| pubmed:authorsComplete |
Y
|
| pubmed:pagination |
259-64
|
| pubmed:dateRevised |
2007-11-15
|
| pubmed:meshHeading |
pubmed-meshheading:1484474-Algorithms,
pubmed-meshheading:1484474-Computer Simulation,
pubmed-meshheading:1484474-Evaluation Studies as Topic,
pubmed-meshheading:1484474-Hospital Mortality,
pubmed-meshheading:1484474-Humans,
pubmed-meshheading:1484474-Infant, Low Birth Weight,
pubmed-meshheading:1484474-Infant, Newborn,
pubmed-meshheading:1484474-Infant Mortality,
pubmed-meshheading:1484474-Intensive Care Units, Neonatal,
pubmed-meshheading:1484474-Models, Statistical,
pubmed-meshheading:1484474-ROC Curve,
pubmed-meshheading:1484474-Risk Factors,
pubmed-meshheading:1484474-Sensitivity and Specificity,
pubmed-meshheading:1484474-Severity of Illness Index,
pubmed-meshheading:1484474-United States
|
| pubmed:articleTitle |
Birthweight-adjusted mortality rates for assessing the effectiveness of neonatal intensive care.
|
| pubmed:affiliation |
Department of Pediatrics, University of Vermont, College of Medicine, Burlington 05405.
|
| pubmed:publicationType |
Journal Article
|