RISK-ADJUSTMENT OF 1-YEAR HEALTH STATUS OUTCOMES IN CAD

调查人员建议使用现有的、完善的 包含基线和一年健康状态数据的临床数据库，用于描述 身心功能、心绞痛负担、生活质量 患者因急性冠脉综合征出院后1年。二 将利用截然不同的临床地点。中美之心 该研究所是一家高容量的转诊中心，提供先进的心脏 关心。杜鲁门医疗中心是一家城市医院，主要为 贫穷的城市患者群体。没有侵入性的心脏手术是 在那里表演。 将在18个月内收集3000多名患者的观察登记 12-18个月(验证队列为1500个)将用于： 1)描述急性呼吸窘迫综合征入院患者的基线和1年健康状况 冠状动脉综合征；2)描述健康状况和 冠状动脉血运重建；3)确定健康状况是否提供了额外的 超标临床变量在预测1年中的预测价值 死亡率；以及4)建立一年健康状况的多变量模型。这个 调查人员强调，他们提出的研究是对声明的回应 AHCPR“支持改善健康成果”的优先领域和 “强化质量计量”。他们还指出，风险调整后的模型 都是医疗保健质量的标志，可以用来 促进患者在知情的情况下做出决定。 本申请已作了重大修改，以响应 本研究部分的初步回顾。急性冠脉病变的分类 随着布朗瓦尔德人的选择，综合症现在已经被编入法典 分类，并扫描心电以供阅读 董事会认证的心脏病专家。生命状态的确定现在已经 澄清了。杜鲁门医疗中心的讨论与支持 已经扩大到同样的规模。识字率低的问题已经得到解决， 已经提供了初步数据。此外，缺乏细节的 分析计划已更正。最后，两者对预算的影响 拟议的专家顾问已被取消。调查人员 有说服力地辩称，他们的研究可能会导致一组截断的 重要的预测变量，将促进其泛化 通过更多地实施其数据收集方法来获得调查结果 可行。

The investigators propose to use an existing, well-established clinical database with baseline and 1-year health status data to describe the physical and mental functioning, angina pectoris burden, quality of life in patients 1-year post hospital discharge for acute coronary syndromes. Two distinctly different clinical sites will be utilized. The Mid-American heart Institute is a high volume, referral center that provides advanced cardiac care. The Truman Medical Center is a city hospital largely serving an indigent, urban patient population. No invasive cardiac procedures are performed there. An observation registry of over 3000 patients will be collected over an 18 months (validation cohort of 1500 between months 12 - 18) will be utilized to: 1) describe baseline and 1-year health status of patients admitted with acute coronary syndromes; 2) describe the association between health status and coronary revascularization; 3) determine if health status provides additional predictive value over standard clinical variables in predicting 1-year mortality; and 4) develop multivariable models of 1-year health status. The investigators highlight that their proposed study is responsive to the stated AHCPR priority areas of "supporting improvement in health outcomes" and "strengthening quality measurement". They also state that risk-adjusted models of health outcomes are both markers of health care quality and may be used to facilitate informed patient decisions. Significant modifications of this application have been made in response to the initial review of this study section. The classification of acute coronary syndromes has now been codified with the selection of the Braunwald classification, and the scanning of the electrocardiograms for reading by board-certified cardiologists. Vital status ascertainment has now been clarified. The discussion of the Truman Medical Center and supported provided to the same has been expanded. Low literacy issues have been addressed and preliminary data have been provided. Also, the lack of detail in the analytical plan has been rectified. Finally, the budgetary impact of the two proposed expert consultants has been neutralized. The investigators persuasively argue that their study will likely lead to a truncated set of important predictor variables that will facilitate generalizability of their findings by making implementation of their data collection approach more feasible.