Adaptation of the Acute Organ Failure Score for Use in a Medicare Population

Objectives: Objectives:Without widely available physiologic data, a need exists for ICU risk adjustment methods that can be applied to administrative data. We sought to expand the generalizability of the Acute Organ Failure Score by adapting it to a commonly used administrative database. Design: Design:Retrospective cohort study. Setting: Setting:One hundred fifty-one hospitals in Pennsylvania. Patients: Patients:A total of 90,733 ICU admissions among 77,040 unique patients between January 1, 2009, and December 1, 2009, in the Medicare Provider Analysis and Review database. Measurements and Main Results: Measurements and Main Results:We used multivariable logistic regression on a random split cohort to predict 30-day mortality, and to examine the impact of using different comorbidity measures in the model and adding historical claims data. Overall 30-day mortality was 17.6%. In the validation cohort, using the original Acute Organ Failure Score model's β coefficients resulted in poor discrimination (C-statistic, 0.644; 95% CI, 0.639–0.649). The model's C-statistic improved to 0.721 (95% CI, 0.711–0.730) when the Medicare cohort was used to recalibrate the β coefficients. Model discrimination improved further when comorbidity was expressed as the COmorbidity Point Score 2 (C-statistic, 0.737; 95% CI, 0.728–0.747; p

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