Background: Factors associated with hospital mortality are usually identified and their effects are quantified through statistical modeling. To guide the choice of the best statistical model, we first quantify the pre...Background: Factors associated with hospital mortality are usually identified and their effects are quantified through statistical modeling. To guide the choice of the best statistical model, we first quantify the predictive ability of each model and then use the CIHI index to see if the hospital policy needs any change. Objectives: The main purpose of this study compared three statistical models in the evaluation of the association between hospital mortality and two risk factors, namely subject’s age at admission and the length of stay, adjusting for the effect of Diagnostic Related Groups (DRG). Methods: We use several SAS procedures to quantify the effect of DRG on the variability in hospital mortality. These procedures are the Logistic Regression model (ignoring the DRG effect), the Generalized Estimating Equation (GEE) that takes into account the within DRG clustering effect (but the within cluster correlation is treated as nuisance parameter), and the Generalized Linear Mixed Model (GLIMMIX). We showed that the GLIMMIX is superior to other models as it properly accounts for the clustering effect of “Diagnostic Related Groups” denoted by DRG. Results: The GLM procedure showed that the proportional contribution of DRG is 16%. All three models showed significant and increasing trend in mortality (P < 0.0001) with respect to the two risk factors (age at admission, and hospital length of stay). It was also clear that the CIHI index was not different under the three models. We re-estimated the models parameters after dichotomizing the risk factors at the optimal cut-off points, using the ROC curve. The parameters estimates and their significance did not change.展开更多
Goals of traditional Chinese medicine(TCM)include precision,accuracy,and recognition by clinical practice.Establishment of a diagnosis and treatment system that closely conforms to the principle-method-recipe-medicine...Goals of traditional Chinese medicine(TCM)include precision,accuracy,and recognition by clinical practice.Establishment of a diagnosis and treatment system that closely conforms to the principle-method-recipe-medicines system and derivation of an accurate diagnosis and treatment plan should be considerations of TCM.Artificial intelligence research based on computer technology is one of the effective ways to solve this problem.In the research of intelligent diagnosis path,reflecting the characteristics of the overall view and dialectical treatment of TCM such as"Combination of four diagnostic methods""overall examination""combination of disease and syndrome"and"treatment individualized to patient,season and locality"are key for successful research of artificial intelligence in TCM diagnosis or recognition by clinical practice.展开更多
文摘Background: Factors associated with hospital mortality are usually identified and their effects are quantified through statistical modeling. To guide the choice of the best statistical model, we first quantify the predictive ability of each model and then use the CIHI index to see if the hospital policy needs any change. Objectives: The main purpose of this study compared three statistical models in the evaluation of the association between hospital mortality and two risk factors, namely subject’s age at admission and the length of stay, adjusting for the effect of Diagnostic Related Groups (DRG). Methods: We use several SAS procedures to quantify the effect of DRG on the variability in hospital mortality. These procedures are the Logistic Regression model (ignoring the DRG effect), the Generalized Estimating Equation (GEE) that takes into account the within DRG clustering effect (but the within cluster correlation is treated as nuisance parameter), and the Generalized Linear Mixed Model (GLIMMIX). We showed that the GLIMMIX is superior to other models as it properly accounts for the clustering effect of “Diagnostic Related Groups” denoted by DRG. Results: The GLM procedure showed that the proportional contribution of DRG is 16%. All three models showed significant and increasing trend in mortality (P < 0.0001) with respect to the two risk factors (age at admission, and hospital length of stay). It was also clear that the CIHI index was not different under the three models. We re-estimated the models parameters after dichotomizing the risk factors at the optimal cut-off points, using the ROC curve. The parameters estimates and their significance did not change.
基金the funding support from the Open Fund Project of State Key Subjects of Chinese Medicine Diagnostics,Hunan University of Chinese Medicine(No.2015ZYZD01).
文摘Goals of traditional Chinese medicine(TCM)include precision,accuracy,and recognition by clinical practice.Establishment of a diagnosis and treatment system that closely conforms to the principle-method-recipe-medicines system and derivation of an accurate diagnosis and treatment plan should be considerations of TCM.Artificial intelligence research based on computer technology is one of the effective ways to solve this problem.In the research of intelligent diagnosis path,reflecting the characteristics of the overall view and dialectical treatment of TCM such as"Combination of four diagnostic methods""overall examination""combination of disease and syndrome"and"treatment individualized to patient,season and locality"are key for successful research of artificial intelligence in TCM diagnosis or recognition by clinical practice.
