Time-dynamic profiling with application to hospital readmission among patients on dialysis.
Biometrics
; 74(4): 1383-1394, 2018 12.
Article
in En
| MEDLINE
| ID: mdl-29870064
ABSTRACT
Standard profiling analysis aims to evaluate medical providers, such as hospitals, nursing homes, or dialysis facilities, with respect to a patient outcome. The outcome, for instance, may be mortality, medical complications, or 30-day (unplanned) hospital readmission. Profiling analysis involves regression modeling of a patient outcome, adjusting for patient health status at baseline, and comparing each provider's outcome rate (e.g., 30-day readmission rate) to a normative standard (e.g., national "average"). Profiling methods exist mostly for non time-varying patient outcomes. However, for patients on dialysis, a unique population which requires continuous medical care, methodologies to monitor patient outcomes continuously over time are particularly relevant. Thus, we introduce a novel time-dynamic profiling (TDP) approach to assess the time-varying 30-day readmission rate. TDP is used to estimate, for the first time, the risk-standardized time-dynamic 30-day hospital readmission rate, throughout the time period that patients are on dialysis. We develop the framework for TDP by introducing the standardized dynamic readmission ratio as a function of time and a multilevel varying coefficient model with facility-specific time-varying effects. We propose estimation and inference procedures tailored to the problem of TDP and to overcome the challenge of high-dimensional parameters when examining thousands of dialysis facilities.
Key words
Full text:
1
Database:
MEDLINE
Main subject:
Patient Readmission
/
Retinal Perforations
/
Biometry
Type of study:
Etiology_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Humans
Language:
En
Year:
2018
Type:
Article