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Letters |1 November 1997

Reply: Predictions of Hospital Mortality Rates

Michael Pine, MD, MBA; Marija Norusis, PhD, MPH; Barbara Jones, MA

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  • University of Chicago Chicago, IL 60637
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IN RESPONSE:
We agree with Drs. Kutner and Rao that validation of a model done by using bootstrapping or split-sample methods is essential for obtaining an unbiased estimate of its goodness of fit. Because our database was large, and because the primary focus of our paper was the comparison of models of several different types, we did not include validation results in our paper. While evaluating hospital performance for large coalitions, we have found that c-statistics remain remarkably stable when models developed on 1 year of data are applied to a subsequent year. The data on acute myocardial infarction presented in our paper illustrate this: From the first year of data to the second, the c-statistic changes from 0.92 to 0.90 for the unrestricted administrative model, changes from 0.76 to 0.75 for the restricted administrative model, changes from 0.86 to 0.87 for the laboratory model, and changes from 0.88 to 0.87 for the clinical model.
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Pine M, Norusis M, Jones B. Reply: Predictions of Hospital Mortality Rates. Ann Intern Med. ;127:847. doi: 10.7326/0003-4819-127-9-199711010-00018

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Published: Ann Intern Med. 1997;127(9):847.

DOI: 10.7326/0003-4819-127-9-199711010-00018

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