PD58-06 IMPLEMENTING AND EVALUATING THE EFFICACY OF AN ACUTE CARE UROLOGY MODEL OF CARE IN A LARGE COMMUNITY HOSPITAL
Bibliographic record
Abstract
INTRODUCTION AND OBJECTIVES:To compare the rate of hospital based outcomes including 30-day readmission rates, perioperative mortality, and length of stay (LOS) in patients with urologic malignancies who underwent surgery as part of treatment in academic and community hospitals METHODS: We retrospectively reviewed the Vizient CDB (Irving, Texas) from September 2014 to December 2017.Vizient includes approximately 97% of academic hospitals (AH) and more than 40 community hospitals (CH).This is a comparative database and measures performance within and between institutions.Data include patient demographics, readmission rates, costs, LOS, case mix index (CMI) and mortality.Patients aged !18 were included and ICD-9 codes were used to identify patients with urologic malignancies who underwent surgical treatment.Chi square and student t-tests were used to compare categorical and continuous variables, respectively RESULTS: We identified a total of 37,628 cases.There were 33,290 (88%) procedures performed in AH and 4,330 (12%) in CH.These included prostatectomy (18,540), radical nephrectomy (rNx) 8,059, partial nephrectomy (pNx) (5,287), radical cystectomy (4,421), radical nephroureterectomy (rNu) (1,006), and partial cystectomy (321).There were no significant differences in 30-day readmission rates or mortality for any procedure between academic and community hospitals (Table 1), p> 0.05 for all.LOS was significantly lower for radical cystectomy and prostatectomy in AH (P<0.01 for both) and lower for rNx in CH (p[0.03).Academic hospitals had a significantly lower amount of partial cystectomies performed when compared to community centers (6.2% vs 16.2% P<0.001), and a similar number of partial nephrectomies performed (39.8% vs 38.0%, P[0.2).The mean direct cost for index admission was significantly higher in AH for rNx, pNx, rNu, and prostatectomy.Case complexity measured using the CMI was similar between the community and academic hospitals CONCLUSIONS: The Vizient CDB provides a novel resource for observational data at US hospitals.Despite academic and community hospitals having similar case complexity, direct costs were lower in community hospitals without an associated increase in readmission rates or deaths.The only clinically significant difference in length of stay was shorter stays for cystectomy in academic centers
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.024 | 0.042 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.004 | 0.002 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.003 | 0.004 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.012 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".