期刊
BMC MEDICAL INFORMATICS AND DECISION MAKING
卷 20, 期 1, 页码 -出版社
BMC
DOI: 10.1186/s12911-020-01169-z
关键词
Effect size; Readmission; Mortality; Diabetes
资金
- WMG, University of Warwick
- HDR UK
- UK Medical Research Council
- Engineering and Physical Sciences Research Council
- Economic and Social Research Council
- Department of Health and Social Care (England)
- Chief Scientist Office of the Scottish Government Health
- Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government)
- Public Health Agency (Northern Ireland)
- British Heart Foundation
- Wellcome Trust
- HDR UK - Medical Research Council [HDR-3001]
Background Patients with diabetes are at an increased risk of readmission and mortality when discharged from hospital. Existing research identifies statistically significant risk factors that are thought to underpin these outcomes. Increasingly, these risk factors are being used to create risk prediction models, and target risk modifying interventions. These risk factors are typically reported in the literature accompanied by unstandardized effect sizes, which makes comparisons difficult. We demonstrate an assessment of variation between standardised effect sizes for such risk factors across care outcomes and patient cohorts. Such an approach will support development of more rigorous risk stratification tools and better targeting of intervention measures. Methods Data was extracted from the electronic health record of a major tertiary referral centre, over a 3-year period, for all patients discharged from hospital with a concurrent diagnosis of diabetes mellitus. Risk factors selected for extraction were pre-specified according to a systematic review of the research literature. Standardised effect sizes were calculated for all statistically significant risk factors, and compared across patient cohorts and both readmission & mortality outcome measures. Results Data was extracted for 46,357 distinct admissions patients, creating a large dataset of approximately 10,281,400 data points. The calculation of standardized effect size measures allowed direct comparison. Effect sizes were noted to be larger for mortality compared to readmission, as well as for being larger for surgical and type 1 diabetes cohorts of patients. Conclusions The calculation of standardised effect sizes is an important step in evaluating risk factors for healthcare events. This will improve our understanding of risk and support the development of more effective risk stratification tools to support patients to make better informed decisions at discharge from hospital.
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