驗證LACE指數運用於各專科病人出院30日內再住院或死亡風險評估適配度：以臺灣某醫學中心為例

Validation and suitability of the LACE index to predict the probability of 30-day readmission or death for patients among different clinical specialties in a medical center in Taiwan

張政國(Cheng-Kuo Chang) ； 江季蓉(Chi-Jung Chiang) ； 林玲玉(Ling-Yu Lin) ； 孫茂勝(Maw-Soan Soon) ； 吳盈瑩(Ying-Ying Wu)

《醫務管理期刊》 18卷4期 (2017/12) Pp. 269-291

https://doi.org/10.6174/JHM2017.18(4).269

摘要

目的：本研究為驗證常用以預測30日內再住院與死亡風險之LACE指數（以下簡稱LACE）於閉鎖性醫療體系及各專科之適配度。方法：採C統計量分析各專科應用LACE預測與實際狀況之一致性，以羅吉斯迴歸之Omnibus檢定及Hosmer and Lemeshow檢定其適配度。結果：從2014至2015年樣本醫院32個專科共88,559名個案納入研究。分析適用LACE預測30日內再住院或死亡風險之科別為一般內科、感染科、全人醫療科、心臟血管內科、腎臟內科、外傷科、泌尿外科、重建整形暨手外科、骨科及神經醫學科，C統計值範圍自0.585至0.684（p＜0.01），預測正確率自84.4至96.4。部分科別由於病人之嚴重度、複雜度與特性不同，適配度不顯著。結論：閉鎖性醫療體系之內、外科系之次專科，多數適用LACE或可經調整而轉為適用；其他獨立專科如婦產科不適用LACE，應針對其病人屬性來發展適合的預測指標。

關鍵字

LACE指數 ； 30日內再住院 ； 死亡風險 ； 風險預測工具

並列摘要

Objectives: The LACE index (hereinafter referred to as LACE) is a tool for predicting the probability of 30-day re-admission or early death. The suitability of LACE with respect to closed physician-hospital organizations still needs to be verified. Therefore, this study aimed to investigate whether or not LACE can be applied to closed physician-hospital organizations and clinical specialties. Methods: C-statistics was used to analyze the consistency of LACE in a prediction model. The Omnibus and Hosmer-Lemeshow tests of logistic regression were used to measure suitability. Results: A total of 88,559 cases from 32 clinical specialties in a medical center from 2014-2015 were included in this study. LACE was shown to be suitable for predicting the probability of 30-day re-admission or death for specialties, such as general internal medicine, infectious disease, holistic medicine, cardiovascular internal medicine, nephrology, trauma surgery, urology, reconstructive, plastic and hand surgery, orthopedics, and neurology. The results of the C-statistic were 0.585-0.684 (p＜0.01), and the H-L test exhibited predictive accuracy of 84.4-96.4. The factors for different specialties such as disease severity, complexity, and care needs, may affect the discriminative ability of LACE to predict the probability of readmission or death. Conclusions: LACE was shown to be suitable for the majority of specialties in internal medicine and surgery within closed physician-hospital organizations. Adding variables may change LACE suitability in some specialties. Independent specialties, such as obstetrics, were not shown to be not suitable for LACE. Hence, these specialties should develop a predictive tool that is suitable for patient characteristics.

並列關鍵字

LACE index ； 30-day readmission ； mortality risk ； risk prediction tool

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