An improved medical admissions risk system using multivariable fractional polynomial logistic regression modelling

Silke, Bernard; Kellett, John; Rooney, Tess; Bennett, Kathleen; O’Riordan, Deirdre

doi:10.1093/qjmed/hcp149

Cited by 111 publications

(122 citation statements)

References 26 publications

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“…We used margins to estimate and interpret adjusted predictions for sub-groups, while controlling for other variables, using computations of average marginal effects. In the multivariate model, we adjusted for previously determined outcome predictor variables of acute illness severity, 15,16 Charlson comorbidity index, 17 sepsis status 18 and chronic disabling disease score. 19 For LOS data, we employed a zero-truncated Poisson regression model including predictive categorical variables in the model as a series of indicator variables.…”

Section: Methodsmentioning

confidence: 99%

Deprivation influences the emergency admission rate of ambulatory care sensitive conditions

et al. 2016

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Section: Methodsmentioning

confidence: 99%

Deprivation influences the emergency admission rate of ambulatory care sensitive conditions

et al. 2016

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“…Bell et al 24 defined the Acute Medical Unit (AMU) as medical wards staffed and equipped to deal exclusively with acute medical patients transferred from emergency department or community for rapid specialist medical and multidisciplinary assessment and treatment. [25][26][27] Those patients who can be stabilized, treated and discharged are managed efficiently in AMU. 28 Key to this is the close co-operation and mutual respect between the complementary specialties.…”

Section: Role Of Internal Medicine In the Future Hospitalmentioning

confidence: 99%

Internal Medicine and emergency admissions: from a national Hospital Discharge Records (SDO) study to a regional analysis

2016

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In Italy, the number of internists has grown by 10% since 1990 reaching 11,435 units, they manage 39,000 beds in 1060 Internal Medicine (IM) wards. The Internists are expected to ensure a cost-effective management of poly-pathological and complex patients. A collaborative study between the Federation of Associations of Hospital Doctors on Internal Medicine (FADOI) and the Consortium for Applied Health Economics Research (C.R.E.A. Sanità) based on data from hospital discharge records has been conducted starting from November 2014. In this article the preliminary results are shown with focus on emergency admissions characteristics to contribute to define the role of hospital IM. Evaluation is performed comparing emergency and planned admissions, IM impact on hospital admissions, availability of community-based healthcare services, diagnosis-related groups (DRGs) weight in IM and regional differences in managing hospital admissions with focus on IM department. In 2013 IM wards discharged 1,073,526 patients (16.18% of the total discharged by hospitals) with a total economic value of 3,426,279.88 € (average DRG 3882.80 €, from 3682.19 to 4083.42). The average length of stay (LOS) in IM was 9.3 days. IM covers 27% of admissions from Emergency Room. Determinants significantly affecting the emergency admissions are old age and comorbidities of the patients that also have a role in increasing LOS. 55% of Italian hospital admissions are emergency admissions. Hospitalization rates in emergency are systematically higher than those in election and the greatest differences are in the regions with inefficiently organized regional network. The role of the hospital IM appears central in the offer of beds to the emergency room by accepting 27% of urgent admissions. The increasing impact of IM on hospital management will put the internists as authoritative stakeholders in health policy.

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“…This has been used as a risk adjustor in our multivariable model. 17,18 The normal range for potassium was considered to lie between 3.5 and 5.0 mmol/l. Based on the frequency distribution, potassium was considered as a continuous and categorical (7 group) variable (<2.5, ≥2.5 <3.0, ≥3.0 <3.5, ≥3.5 <4.3, ≥4.3 <4.7, ≥4.7 <5.2, and ≥5.2 mmol/l).…”

Section: Data Collectionmentioning

confidence: 99%

Serum potassium levels as an outcome determinant in acute medical admissions

et al. 2015

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The relationship between serum potassium levels and mortality in acute medical admissions is uncertain. In particular, the relevance of minor abnormalities in potassium level or variations within the normal range remains to be determined. We performed a retrospective cohort study of all emergency medical admissions to St James's Hospital (Dublin, Ireland) between 2002 and 2012. We used a stepwise logistic regression model to predict in-hospital mortality, adjusting risk estimates for major predictor variables. There were 67,585 admissions in 37,828 patients over 11 years. After removing long-stay patients, 60,864 admissions in 35,168 patients were included in the study. Hypokalaemia was present in 14.5% and hyperkalaemia in 4.9%. In-hospital mortality was 3.9, 5.0, and 18.1% in the normokalaemic, hypokalaemic and hyperkalaemic groups respectively. Hypokalaemic patients had a univariate odds ratio (OR) of 1.29 for in-hospital mortality (95% confi dence interval (CI) 1.16-1.43; p<0.001). Hyperkalaemic patients had a univariate OR for in-hospital mortality of 5.2 (95% CI 4.7-5.7; p<0.001). The ORs for an in-hospital death for potassium between 4.3 and 4.7 mmol/l, and 4.7 and 5.2 mmol/l, were 1.73 (95% CI 1.51-1.99) and 2.97 (95% CI 2.53-3.50) respectively. Hyperkalaemia and hypokalaemia are associated with increased mortality.

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An improved medical admissions risk system using multivariable fractional polynomial logistic regression modelling

Cited by 111 publications

References 26 publications

Deprivation influences the emergency admission rate of ambulatory care sensitive conditions

Deprivation influences the emergency admission rate of ambulatory care sensitive conditions

Internal Medicine and emergency admissions: from a national Hospital Discharge Records (SDO) study to a regional analysis

Serum potassium levels as an outcome determinant in acute medical admissions

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