Effect of changing patient mix on the performance of an intensive care unit severity-of-illness model: how to distinguish a general from a specialty intensive care unit

Critical Care Medicine
R Murphy-FilkinsD W Hosmer

Abstract

To analyze the effects of patient mix diversity on performance of an intensive care unit (ICU) severity-of-illness model. Multiple patient populations were created using computer simulations. A customized version of the Mortality Probability Model (MPM) II admission model was used to ascertain probabilities of hospital mortality. Performance of the model was assessed using discrimination (area under the receiver operating characteristic curve) and calibration (goodness-of-fit testing). Intensive care units. Data were collected from 4,224 ICU patients from two Massachusetts hospitals (Baystate Medical Center, Springfield, MA; University of Massachusetts Medical Center, Worcester, MA) and two New York hospitals (Albany Medical Center, Albany, NY; Ellis Hospital, Schenectady, NY). Random samples were taken from a database. The percentage of patients with each model disease characteristic was varied by assigning weights (ranging from 0 to 10) to patients with a disease characteristic. Three simulations were run for each of 15 model variables at each of 16 weights, totaling 720 simulations. The area under the receiver operating characteristic curve and model fit were assessed in each random sample. Removing patients with a given dis...Continue Reading

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