Analysis of Hospital Mortality Data: The Role of DRG’s ()
Affiliation(s)
1Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada.
2King Fahd Medical City, Riyadh, KSA.
3Department of Biostatistics, Epidemiology, and Scientific Computing, King Faisal Specialist Hospital and Research Center, Riyadh, KSA.
ABSTRACT
Background: Factors associated with hospital mortality are usually identified and
their effects are quantified through statistical modeling. To guide the choice
of the best statistical model, we first quantify the predictive ability of each
model and then use the CIHI index to see if the hospital policy needs any
change. Objectives: The main purpose of this study compared three
statistical models in the evaluation of the association between hospital
mortality and two risk factors, namely subject’s age at admission and the
length of stay, adjusting for the effect of Diagnostic Related Groups (DRG). Methods:
We use several SAS procedures to quantify the effect of DRG on the variability
in hospital mortality. These procedures are the Logistic Regression model (ignoring
the DRG effect), the Generalized Estimating Equation (GEE) that takes into
account the within DRG clustering effect (but the within cluster correlation is
treated as nuisance parameter), and the Generalized Linear Mixed Model
(GLIMMIX). We showed that the GLIMMIX is superior to other models as it
properly accounts for the clustering effect of “Diagnostic Related Groups” denoted by DRG. Results: The GLM procedure showed that the proportional
contribution of DRG is 16%. All three models showed significant and increasing
trend in mortality (P < 0.0001) with respect to the two risk factors (age at
admission, and hospital length of stay). It was also clear that the CIHI index
was not different under the three models. We re-estimated the models parameters
after dichotomizing the risk factors at the optimal cut-off points, using the
ROC curve. The parameters estimates and their significance did not change.
Share and Cite:
Shoukri, M.M., Algahtani, S.N., Eldali, A.M., AlMarzouqi, M.R. and Al-Ageel, S.M. (2019) Analysis of Hospital Mortality Data: The Role of DRG’s. Open Journal of Statistics, 9, 62-73.
https://doi.org/10.4236/ojs.2019.91006
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