Risk Stratification for Congenital Heart Surgery for ICD-10 Administrative Data (RACHS-2).
Risk Stratification for Congenital Heart Surgery for ICD-10 Administrative Data (RACHS-2).
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DOI：
10.1016/j.jacc.2021.11.036
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发表时间：
2022-02-08
影响因子：
24
通讯作者：
New York State CHS-COLOUR
中科院分区：
文献类型：
--
作者：
Allen P;Zafar F;Mi J;Crook S;Woo J;Jayaram N;Bryant R 3rd;Karamlou T;Tweddell J;Dragan K;Cook S;Hannan EL;Newburger JW;Bacha EA;Vincent R;Nguyen K;Walsh-Spoonhower K;Mosca R;Devejian N;Kamenir SA;Alfieris GM;Swartz MF;Meyer D;Paul EA;Billings J;Anderson BR;New York State CHS-COLOUR
由于心脏社区努力改善结果，准确的风险调整方法是必不可少的。自2015年采用国际疾病分类-10 （ICD-10）以来，尚未有公开的方法对行政数据进行先天性心脏手术风险分层。我们的目标是为ICD-10管理数据开发一种经验推导的、公开可用的先天性心脏手术风险分层（RACHS-2）工具。RACHS-2分层系统在儿科健康信息系统的训练数据集中进行了迭代和经验改进，声称与相应的当地胸外科医生-先天性心脏外科学会（STS-CHS）临床注册数据相比，RACHS-2分层系统优化了敏感性和特异性。纽约州医疗补助计划声称，该工具在第二个管理数据源中得到了验证。采用Logistic回归比较管理数据中的RACHS-2预测手术死亡率与登记数据中的STAT死亡率分类的能力。RACHS-2系统捕获了99.6%的先天性心脏手术登记病例，其中1.0%的假阳性。在培训和验证管理数据集中，RACHS-2预测手术死亡率与登记数据中的STAT死亡率类别相似。培训和验证管理数据集的手术死亡率模型（经rachs -2校正）的c统计量分别为0.76和0.84 (95% ci分别为0.72-0.80和0.80-0.89)；相应临床登记数据中手术死亡率模型的c统计量（经STAT死亡率类别调整）分别为0.75和0.84 （95% ci分别为0.71-0.79和0.79-0.89）。RACHS-2是儿科心脏外科ICD-10管理数据的风险分层系统，在两个管理/注册相关数据集中得到验证。统计代码应要求公开提供。自采用国际疾病分类-10 （ICD-10）以来，尚未有公开的方法对行政数据进行先天性心脏手术风险分层。我们的目标是为ICD-10工具开发一个经验衍生的、公开可用的先天性心脏手术风险分层-2 (RACHS-2)，在两个独立的管理数据源中进行验证，并与当地持有的临床注册数据进行比较。RACHS-2检测先天性心脏病病例99.6%，假阳性1.0%。在RACHS-2的行政数据中，手术死亡率的c统计量为0.76 (95% CI 0.72-0.80)，而在相应的STAT死亡率分类的临床登记数据中，c统计量为0.75 （95% CI 0.71-0.79）。统计代码可根据要求提供。
As the cardiac community strives to improve outcomes, accurate methods of risk adjustment are imperative. Since adoption of International Disease Classification-10 (ICD-10) in 2015, there is no published method for congenital heart surgery risk stratification for administrative data. Our objective was to develop an empirically derived, publicly available, Risk Stratification for Congenital Heart Surgery (RACHS-2) tool for ICD-10 administrative data. The RACHS-2 stratification system was iteratively and empirically refined in a training dataset of Pediatric Health Information Systems claims to optimize sensitivity and specificity when compared to corresponding, locally-held Society of Thoracic Surgeons-Congenital Heart Surgery (STS-CHS) clinical registry data. The tool was validated in a second administrative data source, New York State Medicaid claims. Logistic regression was used to compare the ability of RACHS-2 in administrative data to predict operative mortality vs. STAT Mortality Categories in registry data. The RACHS-2 system captured 99.6% of total congenital heart surgery registry cases, with 1.0% false positives. RACHS-2 predicted operative mortality in both training and validation administrative datasets similarly to STAT Mortality Categories in registry data. C-statistics for models for operative mortality in training and validation administrative datasets—adjusted for RACHS-2—were 0.76 and 0.84 (95% CIs 0.72-0.80 and 0.80-0.89); C-statistics for models for operative mortality—adjusted for STAT Mortality Categories—in corresponding clinical registry data were 0.75 and 0.84 (95% CIs 0.71-0.79 and 0.79-0.89). RACHS-2 is a risk stratification system for pediatric cardiac surgery for ICD-10 administrative data, validated in two administrative/registry linked datasets. Statistical code is publicly available upon request. Since adoption of International Disease Classifaction-10 (ICD-10), there has been no published method for congenital heart surgery risk stratification for administrative data. Our objective was to develop an empirically derived, publicly available, Risk Stratification for Congenital Heart Surgery-2 (RACHS-2) for ICD-10 tool, validated in two separate administrative data sources and compared to locally-held clinical registry data. RACHS-2 captured 99.6% of congenital heart cases, with 1.0% false positives. C-statistic for operative mortality was 0.76 (95% CI 0.72-0.80) in administrative data for RACHS-2 vs. 0.75 (95% CI 0.71-0.79) in corresponding clinical registry data for STAT Mortality Categories. Statistical code available upon request.
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影响因子：
5.4
作者：
McSharry, Brent;Straney, Lahn;Slater, Anthony
通讯作者：
Slater, Anthony
影响因子：
24
作者：
Anderson BR;Dragan K;Crook S;Woo JL;Cook S;Hannan EL;Newburger JW;Jacobs M;Bacha EA;Vincent R;Nguyen K;Walsh-Spoonhower K;Mosca R;Devejian N;Kamenir SA;Alfieris GM;Swartz MF;Meyer D;Paul EA;Billings J;New York State Congenital Heart Surgery Collaborative for Longitudinal Outcomes and Utilization of Resources (CHS-COLOUR)
通讯作者：
New York State Congenital Heart Surgery Collaborative for Longitudinal Outcomes and Utilization of Resources (CHS-COLOUR)
影响因子：
1.6
作者：
Jacobs, Jeffrey P.;Jacobs, Marshall L.;Mavroudis, Constantine
通讯作者：
Mavroudis, Constantine
影响因子：
4.6
作者：
O'Brien, Sean M.;Jacobs, Jeffrey P.;Jacobs, Marshall L.
通讯作者：
Jacobs, Marshall L.
DOI：
10.1016/j.jtcvs.2009.03.071
发表时间：
2009-11-01
影响因子：
6
作者：
O'Brien, Sean M.;Clarke, David R.;Edwards, Fred H.
通讯作者：
Edwards, Fred H.