The coxian phase-type distribution as a contribution to the multilevel model of in-hospital mortality

Mariangela Zenga, Adele H. Marshall, Franca Crippa and Hannah Mitchell

Communications in Statistics - Theory and Methods, 2016, vol. 45, issue 6, 1819-1830

Abstract: This paper presents multilevel models that utilize the Coxian phase-type distribution in order to be able to include a survival component in the model. The approach is demonstrated by modeling patient length of stay and in-hospital mortality in geriatric wards in Italy. The multilevel model is used to provide a means of controlling for the existence of possible intra-ward correlations, which may make patients within a hospital more alike in terms of experienced outcome than patients coming from different hospitals, everything else being equal. Within this multilevel model we introduce the use of the Coxian phase-type distribution to create a covariate that represents patient length of stay or stage (of hospital care). Results demonstrate that the use of the multilevel model for representing the in-patient mortality is successful and further enhanced by the inclusion of the Coxian phase-type distribution variable (stage covariate).

Date: 2016
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DOI: 10.1080/03610926.2015.1038394

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