Comparing outcomes of coronary artery bypass surgery: Is the New York Cardiac Surgery Reporting System model sensitive to changes in case mix?
Comparing outcomes of coronary artery bypass surgery: Is the New York Cardiac Surgery Reporting System model sensitive to changes in case mix?
复制标题
比较冠状动脉搭桥手术的结果：纽约心脏手术报告系统模型对病例组合的变化敏感吗？
DOI：
10.1097/00003246-200111000-00008
复制
发表时间：
2001
影响因子：
8.8
通讯作者：
Osler,TM
中科院分区：
文献类型：
--
作者：
Glance,LG;Osler,TM
目的评估使用标准化死亡率比（SMR）的有效性，根据纽约州心脏手术报告系统（CSRS）预测模型，比较冠状动脉旁路移植术（CABG）的结果hospitals.DesignThe研究设计为一项回顾性研究的基础上，数据库包含所有患者接受隔离CABG手术在纽约州医院在1996年（n= 20,078）。在本研究的第一部分中，使用计算机模拟来评估病例组合变化对SMR的影响。使用计算机密集型算法从CSRS数据库中的患者中创建5，000个随机病例混合。与5，000个病例混合中的每一个病例相关的SMR使用恢复算法计算。本研究的第二部分旨在确定在调整病例组合对SMR的影响后，CSRS数据库中所有32家医院的质量离群值是否会发生变化。使用恢复算法获得与CSRS数据库中每家医院的病例组合相关的SMR（医院病例组合SMR）。然后使用CSRS数据库中32家医院的Bootstrapping计算医院SMR（以及95%置信区间）。然后通过将医院SMR除以该医院的病例组合SMR，得出每家医院的调整SMR。设置
ObjectiveTo assess the validity of using the standardized mortality ratio (SMR), based on the New York State Cardiac Surgery Reporting System (CSRS) prediction model to compare coronary artery bypass grafting (CABG) outcomes between hospitals.DesignThe study was designed as a retrospective study based on a database containing all patients undergoing isolated CABG surgery in New York State hospitals in 1996 (n= 20,078). In the first part of this study, a computer simulation was used to assess the impact of case mix variation on the SMR. A computer-intensive algorithm was used to create 5,000 random case mixes from the patients in the CSRS database. The SMR associated with each of the 5,000 case mixes was calculated using a resampling algorithm. The second part of this study was designed to determine whether the identity of quality outliers among all of the 32 hospitals in the CSRS database would change after adjusting for the effects of case mix on the SMR. The SMR associated with the case mix of each hospital in the CSRS database (the hospital case mix SMR) was obtained using a resampling algorithm. The hospital SMR (as well as 95% confidence interval) was then calculated using bootstrapping for each of the 32 hospitals within the CSRS database. An adjusted SMR was then derived for each hospital by dividing the hospital SMR by the case mix SMR for that hospital.Setting