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In addition, we cannot rule out that the improved AAM performance we observed is due to the AAM being evaluated using internal data that is similar to the data in which it was developed, whereas the eCART and NEWS evaluation is being conducted at an with data that is external to the one used to develop those models.
However, our database contains data from 21 hospitals that vary in size, local practices, and culture. Despite these limitations, it remains one of the largest repositories of deterioration events in the world.
Some of the AAM predictors have been controversial in the literature. At KPNC hospitals, when a physician enters admission orders, end-of-life care directives are mandatory (hard stop in the EMR) or the physicians admission orders will not be processed.