Adding Stroke Severity Measure Improves Mortality Risk Models

This article originally appeared here.
Share this content:
Adding Stroke Severity Measure Improves Mortality Risk Models
Adding Stroke Severity Measure Improves Mortality Risk Models

(HealthDay News) -- Adding stoke severity to a hospital 30-day mortality risk model improves model discrimination and hospital performance rankings, according to a study published in the July 18 issue of the Journal of the American Medical Association.

Gregg C. Fonarow, M.D., from the University of California in Los Angeles, and colleagues analyzed data from 782 hospitals participating in Get With The Guidelines-Stroke, representing 127,950 fee-for-service Medicare beneficiaries with ischemic stroke. Participants had a documented score for the National Institutes of Health Stroke Scale (NIHSS). Performance was compared for claim-based hospital mortality risk models, with and without inclusion of NIHSS scores.

The researchers observed significantly better discrimination in the hospital mortality model with NIHSS scores compared to the model without (C statistic, 0.864 versus 0.772). The model with NIHSS scores ranked 26.3 percent of the top 20 percent or the bottom 20 percent of performers differently than the claims model without NIHSS scores. Reclassification by the model with NIHSS scores changed 57.7 percent of hospitals initially classified as "worse than expected" to "as expected." After the addition of NIHSS scores, both net reclassification improvement and integrated discrimination improvement indexes demonstrated significant enhancement (93.1 and 15.0 percent, respectively). The addition of NIHSS scores also improved explained variance and model calibration.

"These findings suggest that it may be critical to collect and include stroke severity for optimal hospital risk adjustment of 30-day mortality for Medicare beneficiaries with acute ischemic stroke," the authors conclude.

The study was funded by the Get With The Guidelines-Stroke program, with support provided by the pharmaceutical industry; several authors disclosed financial ties to the pharmaceutical and biotechnology industries.

Abstract
Full Text
Editorial

Related Resources

You must be a registered member of Cancer Therapy Advisor to post a comment.

Sign Up for Free e-newsletters



Regimen and Drug Listings

GET FULL LISTINGS OF TREATMENT Regimens and Drug INFORMATION

Bone Cancer Regimens Drugs
Brain Cancer Regimens Drugs
Breast Cancer Regimens Drugs
Endocrine Cancer Regimens Drugs
Gastrointestinal Cancer Regimens Drugs
Gynecologic Cancer Regimens Drugs
Head and Neck Cancer Regimens Drugs
Hematologic Cancer Regimens Drugs
Lung Cancer Regimens Drugs
Other Cancers Regimens
Prostate Cancer Regimens Drugs
Rare Cancers Regimens
Renal Cell Carcinoma Regimens Drugs
Skin Cancer Regimens Drugs
Urologic Cancers Regimens Drugs