Luận văn thạc sĩ development and validation of a predictive model for oncology hospital at home
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Luận văn thạc sĩ development and validation of a predictive model for oncology hospital at home
Yale UniversityEliScholar - A Digital Platform for Scholarly Publishing at YaleYale Medicine Thesis Digital LibrarySchool of Medicine43831Development Luận văn thạc sĩ development and validation of a predictive model for oncology hospital at home And Validation Of A Predictive Model For Oncology Hospital-At-HomeKeval Niraj DesaiFollow this and additional works at: https://elischolar.library.yale.edu/ymtdlRecommended CitationDesai. Keval Niraj. 'Development And Validation Of A Predictive Model For Oncology Hospital-At-Home" (2020). Yale Medi Luận văn thạc sĩ development and validation of a predictive model for oncology hospital at home cine Thesis Digital Library. 3894.https://elischolar.library.yale.edu/ymtdl/3894This Open Access Thesis is brought to you for free and open access byLuận văn thạc sĩ development and validation of a predictive model for oncology hospital at home
the School of Medicine at EliScholar - A Digital Platform for Scholarly Publishing at Yale. It has been accepted for inclusion in Yale Medicine ThesisYale UniversityEliScholar - A Digital Platform for Scholarly Publishing at YaleYale Medicine Thesis Digital LibrarySchool of Medicine43831Development Luận văn thạc sĩ development and validation of a predictive model for oncology hospital at home ct elischolar@yale edu.Development and Validation of a Predictive Model for Oncology Ho$pital-at-HomeA Thesis Submitted to the Yale University School of Medicine ill Partial Fulfillment of the Requirements for the Degree of Doctor of MedicineByKeval Niraj Desai2020ABSRACTBackground:llospital-al-llom Luận văn thạc sĩ development and validation of a predictive model for oncology hospital at home c (Hall) is a unique Care model dial allows foi die provision of inpatient level care in the patient's home. HaH has been used to facilitate early disLuận văn thạc sĩ development and validation of a predictive model for oncology hospital at home
charge from inpatient care or to substitute entirely for an inpatient admission, llospilal-al-llome lias been shown to have similar clinical outcomes Yale UniversityEliScholar - A Digital Platform for Scholarly Publishing at YaleYale Medicine Thesis Digital LibrarySchool of Medicine43831Development Luận văn thạc sĩ development and validation of a predictive model for oncology hospital at home disease is a promising avenue to reduce healthcare costs while improving patients' quality of life by increasing time spent at home. A major challenge to implementing a Hospital-at-llome program for cancer patients is the lack of validated criteria to inform the selection of admissions most suitabl Luận văn thạc sĩ development and validation of a predictive model for oncology hospital at home e for home-based hospital level care.Methods and Results:Admissions to the Yale New Haven Smilow Cancer Hospital’s medical oncology door in New HavenLuận văn thạc sĩ development and validation of a predictive model for oncology hospital at home
from Jan 2015- Jun 2019 were included in the analysis (N=3.322). The analysis focused entirely on patients with solid minors hospitalized for unplanneYale UniversityEliScholar - A Digital Platform for Scholarly Publishing at YaleYale Medicine Thesis Digital LibrarySchool of Medicine43831Development Luận văn thạc sĩ development and validation of a predictive model for oncology hospital at home t would be difficult to deliver or were inconsistent with sate care in the home. Iwciity-scven-poiiil-thrcc percent of admissions were identified as suitable for Hall. accounting for 908 admissions during the study period. Admissions that were suitable for HaH were shorter hi duration (2.79 vs 6.11 Luận văn thạc sĩ development and validation of a predictive model for oncology hospital at home days), more likely to result in discharge home rather than to other healthcare facility (87.5% vs 69.5%), and less likely to be readmitted in the follLuận văn thạc sĩ development and validation of a predictive model for oncology hospital at home
owing 30 days (25.3% vs 31.5%). A predictive logistic model constructed using a purposeful selection process identified 13 statistically significant pYale UniversityEliScholar - A Digital Platform for Scholarly Publishing at YaleYale Medicine Thesis Digital LibrarySchool of Medicine43831Development Luận văn thạc sĩ development and validation of a predictive model for oncology hospital at home or oncology extended care center (vs admitted directly from clinic), primary admission diagnosis of secondary malignancy, primary admission diagnosis of fever, primary' admission diagnosis of digestive diseases, oncology diagnosis of secondary or unknown malignancy, initial pre-admission respiratory Luận văn thạc sĩ development and validation of a predictive model for oncology hospital at home ' rate >20 breaths. 111111. final pre*admission systolic blood pressure <100 mmHg, final pie-admission temperature >100° F. Sodium < 135 nunolL, hemogLuận văn thạc sĩ development and validation of a predictive model for oncology hospital at home
lobin <10 g dL and ED visit in the previous 90 days. The predictive model had moderate discrimination (c-statistic 0.686) and was well calibrated in tYale UniversityEliScholar - A Digital Platform for Scholarly Publishing at YaleYale Medicine Thesis Digital LibrarySchool of Medicine43831Development Luận văn thạc sĩ development and validation of a predictive model for oncology hospital at home patients. Tins model sen es as a starting point to creating selection criteria and can be further relined and tested in prospective validation and pilot studies. The modest discrimination of the model indicates that much of the variability that allows for accurate prediction is still unaccounted for Luận văn thạc sĩ development and validation of a predictive model for oncology hospital at home and would benefit from larger studies and inclusion of clinician judgementACKNOWLEDGEMENTSFirst. I would like to thank God for the many blessings heLuận văn thạc sĩ development and validation of a predictive model for oncology hospital at home
has bestowed on my life, including the plivilege to stud)' medicine at such a wonderfill institution My parents. who shaped my personality and charactYale UniversityEliScholar - A Digital Platform for Scholarly Publishing at YaleYale Medicine Thesis Digital LibrarySchool of Medicine43831Development Luận văn thạc sĩ development and validation of a predictive model for oncology hospital at home gement I have learned to be resilient in adversity and humble 111 accomplishment. My spiritual teacher and Guru, the late Pandurang Shastri Athavale (Dadaji). has played an almost invisible hand in making me the person I am today, and I was privileged to spend two years at an institution he founded Luận văn thạc sĩ development and validation of a predictive model for oncology hospital at home to teach applied philosophy and spirituality to students from around the world. My fiancé Uslima has been a constant source of support and love sinceLuận văn thạc sĩ development and validation of a predictive model for oncology hospital at home
the day we met. I owe my deep gratitude to countless mentors, teachers, friends, and colleagues who have shaped me as a physician and become role modeYale UniversityEliScholar - A Digital Platform for Scholarly Publishing at YaleYale Medicine Thesis Digital LibrarySchool of Medicine43831Development Luận văn thạc sĩ development and validation of a predictive model for oncology hospital at home d critical mentorship and guidance 111 the writing of this thesis. Soimdan Sureshanand from the Yale JDAT team has been immensely helpfill with getting the data for this project and answering our many questions. Without her this project would not have been completed in a timely fashion. Dr. Kerin Ad Luận văn thạc sĩ development and validation of a predictive model for oncology hospital at home elson and Dr. Cary Gross have provided timely comments and input into the project from their personal expertise that has been immensely helpfill. AlexLuận văn thạc sĩ development and validation of a predictive model for oncology hospital at home
andra Hajduk has provided critical statistical insight into the methods 111 this thesis.Table of ContentsINTRODUCTION.................................Yale UniversityEliScholar - A Digital Platform for Scholarly Publishing at YaleYale Medicine Thesis Digital LibrarySchool of Medicine43831Development Luận văn thạc sĩ development and validation of a predictive model for oncology hospital at home d Complications in Hall.............................5Oncology Hospital-at-Home........................................................7Statement of Purpose and Specific Aims..........................................10 Luận văn thạc sĩ development and validation of a predictive model for oncology hospital at home Yale UniversityEliScholar - A Digital Platform for Scholarly Publishing at YaleYale Medicine Thesis Digital LibrarySchool of Medicine43831DevelopmentGọi ngay
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