Journal of the Korean Data and Information Science Society

The Korean Data and Information Science Society (한국데이터정보과학회)
권호 표지

A study on analysis of factors on in-hospital mortality for community-acquired pneumonia

지역사회획득 폐렴 환자의 퇴원시 사망 요인 분석

  • Kim, Yoo-Mi (Dept. of Health Policy & Management, Sangji University)
  • Received : 2011.02.01
  • Accepted : 2011.03.25
  • Published : 2011.05.31
Download PDF
⟨ Previous Next ⟩

Abstract

This study was carried out to analysis factors related to in-hospital mortality of community-acquired peumonia using administrative database. The subjects were 5,353 community-acquired pneumonia inpatients of the Korean National Hospital Discharge Injury Survey 2004-2006 data. The data were analyzed using chi-squared test and decision tree model in the data mining technique. Among the decision tree model, C4.5 had the best performance. The critical factors on in-hospital mortality of communityacquired pneumonia are admission route, respiratory failure, congenital heart failure including age, comorbidity, and bed size. This study was carried out using the administrative database including patients' characteristics and comorbidity. However further study should be extensively including hospital characteristics, regional medical resources, and patient management practice behavior.

본 연구의 목적은 행정자료를 이용하여 지역사회획득 폐렴 환자의 사망 요인을 분석하기 위해 수행되었다. 2004~2006년 퇴원손상환자 조사자료 중 지역사회획득 폐렴환자 5,353건을 연구대상으로 하였으며, 사망률의 차이분석은 카이제곱 검정을 실시하였고, 사망 요인을 분석하기 위해 데이터마이닝 기법 중 의사결정나무 모형을 이용하였다. 의사결정나무 모형 중 C4.5가 성능이 우수하였는데, 입원경로, 호흡부전, 울혈성심부전을 포함하여 연령, 동반질환, 병상규모 등이 폐렴 사망의 위험 요인으로 나타났다. 본 연구는 행정데이터를 이용하여 지역사회획득 폐렴환자의 사망 위험요인을 밝히고자 하였다. 그러나 향후 병원특성, 지역특성, 의료행태 등에 대한 보다 포괄적인 변수를 포함한 후속 연구가 필요할 것으로 생각된다.

Keywords

References

  1. 강성홍 (2009). 퇴원환자의 재원일수 변이 분석: 2004-2006년 퇴원손상심층조사 결과 중심으로. <주간건강과질병>, 2, 857-866.
  2. 윤영경, 김정연, 박윤선, 박대원, 손장욱, 엄중식, 천병철, 김은주, 김민자 (2008). 한국에서 2004년에 발생한 지역 사회 폐렴의 역학 및 항생제 사용 행태. <대한내과학회지>, 75, 549-550.
  3. 이용구, 허준 (2009). 생명보험사의 개인연금 보험예측 사례를 통해서 본 의사결정나무 분석의 설명변수 축소에 관한 비교 연구. <한국데이터정보과학회지>, 20, 179-190.
  4. 최종후, 서두성 (1999). 데이터마이닝 의사결정나무의 응용. <통계분석연구>, 4, 61-83.
  5. Aiken, L. H., Clarke, S. P., Sloane, D. M., Sochalski, J. and Silber, J. H. (2002). Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. The Journal of the American Medical Association, 288, 1987-1993. https://doi.org/10.1001/jama.288.16.1987
  6. Aylin, P., Bottle, A. and Majeed, A. (2007). Use of administrative data or clinical databases as predictors of risk of death in hospital: Comparison of models. British Medical Journal (Clinical Research Ed.), 334, 1044. https://doi.org/10.1136/bmj.39168.496366.55
  7. Ben-Tovim, D., Woodman, R., Harrison, J., Pointer, S., Hakendorf, P. and Henley, G. (2009). Measuring and reporting mortality in hospital patients, Australian Institute of Health and Welfare, Canberra.
  8. Bratzler, D. W., Nsa, W. and Houck, P. M. (2007). Performance measures for pneumonia: Are they valuable, and are process measures adequate? Current Opinion in Infectious Diseases, 20, 182-189. https://doi.org/10.1097/QCO.0b013e3280495468
  9. Canadian Institute for Health Information (CIHI). (2007). HSMR: A new approach for measuring hospital mortality trends in Canada, CIHI, Ottawa.
  10. Ellrodt, G., Cook, D. J., Lee, J., Cho, M., Hunt, D. and Weingarten, S. (1997). Evidence-based disease management. The Journal of the American Medical Association, 278, 1687-1692. https://doi.org/10.1001/jama.1997.03550200063033
  11. Fine, M. J., Auble, T. E., Yealy, D. M., Hanusa, B. H., Weissfeld, L. A., Singer, D. E., Coley, C. M., Marrie, T. J. and Kapoor, W. N. (1997). A prediction rule to identify low-risk patients with communityacquired pneumonia. The New England Journal of Medicine, 336, 243-250. https://doi.org/10.1056/NEJM199701233360402
  12. Fine, M. J., Smith, M. A., Carson, C. A., Mutha, S. S., Sankey, S. S., Weissfeld, L. A. and Kapoor, W. N. (1996). Prognosis and outcomes of patients with community-acquired pneumonia. A meta-analysis. The Journal of the American Medical Association, 275, 134-141. https://doi.org/10.1001/jama.1996.03530260048030
  13. Garnick, D. W., DeLong, E. R. and Luft, H. S. (1995). Measuring hospital mortality rates: Are 30-day data enough? Health Services Research, 29, 679-695.
  14. Hartz, A. J., Krakauer, H., Kuhn, E. M., Young, M., Jacobsen, S. J., Gay, G., Muenz, L., Katzoff, M., Bailey, R. C. and Rimm, A. A. (1989). Hospital characteristics and mortality rates. The New England Journal of Medicine, 321, 1720-1725. https://doi.org/10.1056/NEJM198912213212506
  15. Iezzoni, L. I. (1997a). Assessing quality using administrative data. Annals of Internal Medicine, 127, 666-674. https://doi.org/10.7326/0003-4819-127-8_Part_2-199710151-00048
  16. Iezzoni, L. I. (1997b). The risks of risk adjustment. The Journal of the American Medical Association, 278, 1600-1607. https://doi.org/10.1001/jama.1997.03550190064046
  17. Jarman, B., Gault, S., Alves, B., Hider, A., Dolan, S., Cook, A., Hurwitz, B. and Iezzoni, L. I. (1999). Explaining differences in english hospital death rates using routinely collected data. British Medical Journal (Clinical Research Ed.), 318, 1515-1520. https://doi.org/10.1136/bmj.318.7197.1515
  18. Jasti, H., Mortensen, E. M., Obrosky, D. S., Kapoor, W. N. and Fine, M. J. (2008). Causes and risk factors for rehospitalization of patients hospitalized with community-acquired pneumonia. Clinical Infectious Diseases, 46, 550-556.
  19. Jin, Y., Marrie, T. J., Carriere, K. C., Predy, G., Houston, C., Ness, K. and Johnson, D. H. (2003). Variation in management of community-acquired pneumonia requiring admission to Alberta, Canada hospitals. Epidemiology and Infection, 130, 41-51. https://doi.org/10.1017/S0950268802007926
  20. Korea National Statistical Office. (2010). An nual report on the cause of death statistics 2009: Nationalwide, National Statistical Office, Daejeon.
  21. Krakauer, H., Bailey, R. C., Skellan, K. J., Stewart, J. D., Hartz, A. J., Kuhn, E. M. and Rimm, A. A. (1992). Evaluation of the HCFA model for the analysis of mortality following hospitalization. Health Services Research, 27, 317-335.
  22. Lave, J. R., Fine, M. J., Sankey, S. S., Hanusa, B. H., Weissfeld, L. A. and Kapoor, W. N. (1996). Hospitalized pneumonia. outcomes, treatment patterns, and costs in urban and rural areas. Journal of General Internal Medicine, 11, 415-421. https://doi.org/10.1007/BF02600189
  23. Lee, J. Y. and Lee, Y. W. (2004). Receiver operating characteristic(ROC) curves using neural network in classification. Journal of the Korean Data & Information Science Society, 15, 911-920.
  24. Lee, Y. W., Jung, J. W., Song, J. H., Jeon, E. J., Choi, J. C., Shin, J. W., Kim, J. Y., Park, I. W. and Choi, B. W. (2006). Risk factors for mortality in community-acquired pneumonia patients admitted to a referral hospital. Tuberculosis and Respiratory Diseases, 61, 347-355. https://doi.org/10.4046/trd.2006.61.4.347
  25. Marrie, T. J., Carriere, K. C., Jin, Y. and Johnson, D. H. (2003). Mortality during hospitalisation for pneumonia in alberta, canada, is associated with physician volume. The European Respiratory Journal, 22, 148-155. https://doi.org/10.1183/09031936.03.00115703
  26. Marrie, T. J. and Wu, L. (2005). Factors influencing in-hospital mortality in community-acquired pneumonia: A prospective study of patients not initially admitted to the ICU. Chest, 127, 1260-1270. https://doi.org/10.1378/chest.127.4.1260
  27. Metlay, J. P., Schulz, R., Li, Y. H., Singer, D. E., Marrie, T. J., Coley, C. M., Coley, C. M., Hough, L. J., Obrosky, D. S., Kapoor, W. N. and Fine, M. J. (1997). Influence of age on symptoms at presentation in patients with community-acquired pneumonia. Archives of Internal Medicine, 157, 1453-1459. https://doi.org/10.1001/archinte.1997.00440340089009
  28. Moon, S., Lee, J. S., Kim, Y., You, S. J., Choi, Y. K., Suh, S. K. and Kim, Y. I. (2009). Quality and affecting factor of care for patients hospitalized with pneumonia. Tuberculosis and Respiratory Diseases, 66, 300-308. https://doi.org/10.4046/trd.2009.66.4.300
  29. Niederman, M. S., Bass, J. B.,Jr, Campbell, G. D., Fein, A. M., Grossman, R. F., Mandell, L. A., Marrie, T. J., Sarosi, G. A., Torres, A. and Yu, V. L. (1993). Guidelines for the initial management of adults with community-acquired pneumonia: Diagnosis, assessment of severity, and initial antimicrobial therapy. The American Review of Respiratory Disease, 148, 1418-1426. https://doi.org/10.1164/ajrccm/148.5.1418
  30. Niederman, M. S. and Peters, S. P. (1998). Update in pulmonary medicine. Annals of Internal Medicine, 128, 208-215. https://doi.org/10.7326/0003-4819-128-3-199802010-00007
  31. Oh, H. K., Seo, J. Y., Kim, D. K., Choi, J. E., Mo, E. K., Park, M. J., Lee,M.G., Hyun, I. G. and Jung, K. S. (1997). Clinical characteristics and prognostic factors of severe community-acquired pneumonia. Tuberculosis and Respiratory Diseases, 44, 1072-1082. https://doi.org/10.4046/trd.1997.44.5.1072
  32. Omoigui, N. A., Miller, D. P., Brown, K. J., Annan, K., Cosgrove, D.,3rd, Lytle, B., Loop, F. and Topol, E. J. (1996). Outmigration for coronary bypass surgery in an era of public dissemination of clinical outcomes. Circulation, 93, 27-33. https://doi.org/10.1161/01.CIR.93.1.27
  33. Ortqvist, A., Sterner, G. and Nilsson, J. A. (1985). Severe community-acquired pneumonia: Factors influencing need of intensive care treatment and prognosis. Scandinavian Journal of Infectious Diseases, 17, 377-386.
  34. Pachon, J., Prados, M. D., Capote, F., Cuello, J. A., Garnacho, J. and Verano, A. (1990). Severe community-acquired pneumonia. etiology, prognosis, and treatment. The American Review of Respiratory Disease, 142, 369-373. https://doi.org/10.1164/ajrccm/142.2.369
  35. Park C. and Song G. M. (2002). Analysis of students leaving their majors using decision tree. Journal of the Korean Data & Information Science Society, 13, 157-165.
  36. Park, H. P., Seo, Y. W., Lee, J. E., Kim, Y. H., Jang, Y. Y., Park, S. H., Seo, C. K., Jeon, Y. J., Lee, M. Y. and Choi, W. I. (2005). Factors associated with early death in patients with community-acquired pneumonia. Tuberculosis and Respiratory Diseases, 58, 607-613. https://doi.org/10.4046/trd.2005.58.6.607
  37. Park, H. C. and Cho, K. H. (2004). Modeling of environmental survey by decision trees. Journal of the Korean Data & Information Science Society, 15, 759-771.
  38. Polanczyk, C. A., Lane, A., Coburn, M., Philbin, E. F., Dec, G. W. and DiSalvo, T. G. (2002). Hospital outcomes in major teaching, minor teaching, and nonteaching hospitals in New York state. The American Journal of Medicine, 112, 255-261. https://doi.org/10.1016/S0002-9343(01)01112-3
  39. Rosenthal, G. E., Baker, D. W., Norris, D. G., Way, L. E., Harper, D. L. and Snow, R. J. (2000). Relationships between in-hospital and 30-day standardized hospital mortality: Implications for profiling hospitals. Health Services Research, 34, 1449-1468.
  40. Shahian, D. M. and Normand, S. L. (2008). Comparison of "risk-adjusted" hospital outcomes. Circulation, 117, 1955-1963. https://doi.org/10.1161/CIRCULATIONAHA.107.747873
  41. Song, J. H. and Jung, K. S. (2010). Treatment guidelines for community-acquired pneumonia in korea: An evidence-based approach to appropriate antimicrobial therapy. Journal of Korean Medical Association, 53, 20-42. https://doi.org/10.5124/jkma.2010.53.1.20
  42. Won, C. W. (2010). Community acquired pneumonia. Korean Journal of Family Medicine, 31, 503-511. https://doi.org/10.4082/kjfm.2010.31.7.503