Risk Adjustment for Comparing Hospital Quality with Surgery: How Many Variables Are Needed?
Risk Adjustment for Comparing Hospital Quality with Surgery: How Many Variables Are Needed?
复制标题
DOI：
10.1016/j.jamcollsurg.2010.01.018
复制
发表时间：
2010-04-01
影响因子：
5.2
通讯作者：
Birkmeyer, John D.
中科院分区：
文献类型：
--
作者：
Dimick, Justin B.;Osborne, Nicholas H.;Birkmeyer, John D.
背景：美国外科医师学会的国家外科质量改进计划(ACS NSQIP)将很快报告特定程序的结果，并希望通过收集更少的变量来减少数据收集的负担。我们试图确定这些变化是否威胁到医院质量比较风险调整的稳健性。STUDY设计：我们使用了2005至2007年来自ACS NSQIP的前瞻性临床数据(184家医院，74,887名患者)。对于全模型(21个变量)、中间模型(12个变量)和有限模型(5个变量)，我们比较了全模型(21个变量)、中间模型(12个变量)和有限模型(5个变量)在预测患者预后和风险调整医院结果方面的能力。在患者风险评估中，有限模型和完整模型在患者水平上具有非常相似的区分性(所有5种手术的C指数合并后死亡率分别为0.93和0.91，发病率分别为0.78和0.76)，并显示出对患者风险各层次的良好校准。在评估特定医院的结果时，有限和完全风险模型的结果与死亡率(在5次手术中的范围在0.94到0.99之间)和发病率(在0.96到0.99之间)高度相关。结论：特定于程序的医院质量测量可以用有限数量的变量进行充分的风险调整。在ACSNSQIP的背景下，转向更有限的模型将极大地减轻参与的医院收集数据的负担。(J am Coll Surg 2010；210：503-508。由Elsevier Inc.代表美国外科医生学会出版)
BACKGROUND: The American College of Surgeons' National Surgical Quality Improvement Program (ACS NSQIP) will soon be reporting procedure-specific outcomes, and hopes to reduce the burden of data collection by collecting fewer variables. We sought to determine whether these changes threaten the robustness of the risk adjustment of hospital quality comparisons.STUDY DESIGN: We used prospective, clinical data from the ACS NSQIP from 2005 to 2007 (184 hospitals, 74,887 patients). For the 5 general surgery operations in the procedure-specific NSQIP, we compared the ability of the full model (21 variables), an intermediate model (12 variables), and a limited model (5 variables) to predict patient outcomes and to risk-adjust hospital outcomes.RESULTS: The intermediate and limited models were comparable with the full model in all analyses. In the assessment of patient risk, the limited and full models had very similar discrimination at the patient level (C-indices for all 5 procedures combined of 0.93 versus 0.91 for mortality and 0.78 versus 0.76 for morbidity) and showed good calibration across strata of patient risk. In assessing hospital-specific outcomes, results from the limited and full-risk models were highly correlated for both mortality (range 0.94 to 0.99 across the 5 operations) and morbidity (range 0.96 to 0.99).CONCLUSIONS: Procedure-specific hospital quality measures can be adequately risk-adjusted with a limited number of variables. In the context of the ACS NSQIP moving to a more limited model will dramatically reduce the burden of data collection for participating hospitals. (J Am Coll Surg 2010;210:503-508. Published by Elsevier Inc. on behalf of the American College of Surgeons)