Development and validation of a continuous measure of patient condition using the Electronic Medical Record

• Published in: Journal of biomedical informatics 2013-10, Vol.46 (5), p.837-848
• Main Authors: Rothman, Michael J., Rothman, Steven I., Beals, Joseph
• Format: Article
• Language: English
• Subjects: Acuity score; APACHE; Deterioration; Electronic health records; Health Status; Health status indicators; Humans; Logistic Models; Medical Records Systems, Computerized - standards; Models, Theoretical; Mortality; Nursing assessments; Patient condition; Patient Discharge; Patient Readmission; Patients; ROC Curve
• ISSN: 1532-0464; 1532-0480
• DOI: 10.1016/j.jbi.2013.06.011

[Display omitted] •New method to estimate patient condition during a hospital visit.•Patient condition is computed by summing risks measured in each of 26 variables.•Leverages data already in the EMR: vital signs, lab results, nursing assessments.•Rothman Index, a measure of patient condition, is independent of diagnosis and spans all acuity levels.•May help clinicians to improve continuity of care and to detect trends. Patient condition is a key element in communication between clinicians. However, there is no generally accepted definition of patient condition that is independent of diagnosis and that spans acuity levels. We report the development and validation of a continuous measure of general patient condition that is independent of diagnosis, and that can be used for medical-surgical as well as critical care patients. A survey of Electronic Medical Record data identified common, frequently collected non-static candidate variables as the basis for a general, continuously updated patient condition score. We used a new methodology to estimate in-hospital risk associated with each of these variables. A risk function for each candidate input was computed by comparing the final pre-discharge measurements with 1-year post-discharge mortality. Step-wise logistic regression of the variables against 1-year mortality was used to determine the importance of each variable. The final set of selected variables consisted of 26 clinical measurements from four categories: nursing assessments, vital signs, laboratory results and cardiac rhythms. We then constructed a heuristic model quantifying patient condition (overall risk) by summing the single-variable risks. The model’s validity was assessed against outcomes from 170,000 medical-surgical and critical care patients, using data from three US hospitals. Outcome validation across hospitals yields an area under the receiver operating characteristic curve(AUC) of ⩾0.92when separating hospice/deceased from all other discharge categories, an AUC of ⩾0.93 when predicting 24-h mortalityand an AUC of 0.62 when predicting 30-day readmissions. Correspondence with outcomesreflective of patient condition across the acuity spectrum indicates utility in both medical-surgical unitsand critical care units. The model output, which we call the Rothman Index, may provide clinicians witha longitudinal view of patient condition to help address known challenges in caregiver communication,continuity of care, and earlier detection of acuit