Comparing AMI mortality among hospitals in patients 65 years of age and older - Evaluating methods of risk adjustment
Comparing AMI mortality among hospitals in patients 65 years of age and older - Evaluating methods of risk adjustment
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DOI：
10.1161/01.cir.99.23.2986
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发表时间：
1999-06-15
期刊：
影响因子：
37.8
通讯作者：
Marciniak, TA
中科院分区：
文献类型：
--
作者：
Krumholz, HM;Chen, J;Marciniak, TA
背景：对急性心肌梗死患者风险调整后结果的报道越来越感兴趣。一个有用的风险调整模型必须在数据收集的简洁性和易用性与预测能力之间取得平衡。方法和结果：通过对2401家医院的82359例大于或等于65岁的急性心肌梗死患者的分析，我们得出了一个预测30天死亡率的简约模型。该模型在来自2386家医院的78699名患者中得到了验证。在检查的73个候选预测变量中，7个描述患者到达时特征的变量被选择纳入最终模型：年龄、心脏骤停、心肌梗死的前部或外侧位置、收缩压、白细胞计数、血清肌酐和充血性心力衰竭。衍生组和验证组最终模型的接受者-工作特征曲线下面积分别为0.77和0.77。使用该模型的医院绩效排名（以十分位数为单位）与基于医疗图表审查的27个变量综合模型最相似，与基于行政计费代码的模型最不相似。结论：一个简单的7变量风险模型和更复杂的模型在比较急性心肌梗死的医院预后方面表现良好。尽管仍需要改进风险调整方法，但我们的结果为医院开发一种简单的方法来比较结果提供了基础。
Background-Interest in the reporting of risk-adjusted outcomes for patients with acute myocardial infarction is growing. A useful risk-adjustment model must balance parsimony and ease of data collection with predictive ability.Methods and Results-From our analysis of 82 359 patients greater than or equal to 65 years of age admitted with acute myocardial infarction to 2401 hospitals, we derived a parsimonious model that predicts 30-day mortality. The model was validated on a similar group of 78 699 patients from 2386 hospitals. Of the 73 candidate predictor variables examined, 7 variables describing patient characteristics on arrival were selected for inclusion in the final model: age, cardiac arrest, anterior or lateral location of myocardial infarction, systolic blood pressure, white blood cell count, serum creatinine, and congestive heart failure. The area under the receiver-operating characteristic curve for the final model was 0.77 in the derivation cohort and 0.77 in the validation cohort. The rankings of hospitals by performance (in deciles) with this model were most similar to a comprehensive 27-variable model based on medical chart review and least similar to models based on administrative billing codes.Conclusions-A simple 7-variable risk model performs as well as more complex models in comparing hospital outcomes for acute myocardial infarction. Although there is a continuing need to improve methods of risk adjustment, our results provide a basis for hospitals to develop a simple approach to compare outcomes.