论文标题
估计经风险调整的医院绩效
Estimating Risk-Adjusted Hospital Performance
论文作者
论文摘要
医院提供的医疗保健质量可能会发生很大的可变性。因此,对医院绩效的准确度量对于包括患者,医院经理和健康保险公司在内的各种决策者至关重要。通过患者的健康结果评估医院的表现。但是,随着医院之间患者的风险概况的变化,衡量医院表现需要调整患者风险。该任务是通过层次概括的线性模型在最新过程中形式化的,该模型将医院的固定效应与患者风险对健康结果的影响分离出来。由于这种方法的线性性质,因此忽略了风险变量之间的任何非线性关系或相互作用项。 在这项工作中,我们提出了一种用于测量患者风险调整的医院绩效的新方法。该方法捕获了非线性关系以及患者风险变量之间的相互作用,特别是同时发生的健康状况对健康结果的影响。为此,我们开发了一种量身定制的神经网络体系结构,该结构可以部分解释:非线性部分用于编码风险因素,而线性结构模型医院固定效应,以便可以估算出风险调整的医院绩效。我们对全国性读入学数据库提供的近1,900家美国医院的1300万名患者入院进行评估。我们的模型将ROC-AUC改善了最先进的AUC 4.1%。这些发现表明,健康结果的很大一部分可以归因于患者风险变量之间的非线性关系,并暗示应扩大目前的测量医院绩效的方法。
The quality of healthcare provided by hospitals is subject to considerable variability. Consequently, accurate measurements of hospital performance are essential for various decision-makers, including patients, hospital managers and health insurers. Hospital performance is assessed via the health outcomes of their patients. However, as the risk profiles of patients between hospitals vary, measuring hospital performance requires adjustment for patient risk. This task is formalized in the state-of-the-art procedure through a hierarchical generalized linear model, that isolates hospital fixed-effects from the effect of patient risk on health outcomes. Due to the linear nature of this approach, any non-linear relations or interaction terms between risk variables are neglected. In this work, we propose a novel method for measuring hospital performance adjusted for patient risk. This method captures non-linear relationships as well as interactions among patient risk variables, specifically the effect of co-occurring health conditions on health outcomes. For this purpose, we develop a tailored neural network architecture that is partially interpretable: a non-linear part is used to encode risk factors, while a linear structure models hospital fixed-effects, such that the risk-adjusted hospital performance can be estimated. We base our evaluation on more than 13 million patient admissions across almost 1,900 US hospitals as provided by the Nationwide Readmissions Database. Our model improves the ROC-AUC over the state-of-the-art by 4.1 percent. These findings demonstrate that a large portion of the variance in health outcomes can be attributed to non-linear relationships between patient risk variables and implicate that the current approach of measuring hospital performance should be expanded.