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

研究人员建议使用现有的、完善的 包含基线和1年健康状况数据的临床数据库，用于描述 身心功能，心绞痛负荷，生活质量 患者因急性冠状动脉综合征出院后1年。 两 将使用明显不同的临床站点。美国中部心脏 研究所是一个高容量，转诊中心，提供先进的心脏 在乎杜鲁门医疗中心是一家城市医院，主要服务于 贫困的城市患者群体。没有侵入性心脏手术 在那里演出。 将在18个月内收集超过3000名患者的观察登记资料。 个月（12 - 18个月之间的1500个验证队列）将用于： 1)描述急性心肌梗死住院患者的基线和1年健康状况 冠状动脉综合征; 2）描述健康状况与 冠状动脉血运重建; 3）确定健康状况是否提供额外的 在预测1年时，相对于标准临床变量的预测值 死亡率;和4）开发1年健康状况的多变量模型。的 研究人员强调，他们提出的研究是对所述 AHCPR优先领域“支持改善卫生成果”， “强化质量衡量”。他们还指出，风险调整模型 的健康结果都是卫生保健质量的标志，可用于 帮助患者做出明智的决定。 本申请的重大修改是为了响应 本研究部分的初步审查。急性冠脉综合征的分类 综合征现在已经编纂与选择布朗瓦尔德 分类，并扫描心电图进行阅读， 认证的心脏病专家生命状态的确定 明确了杜鲁门医疗中心的讨论和支持提供 同样的事情已经扩大了。识字率低的问题已经得到解决， 已提供初步数据。此外，缺乏细节， 分析计划已被修改。最后，两者的预算影响 拟议的专家顾问已被取消。调查人员 令人信服地认为，他们的研究可能会导致一个截断集， 重要的预测变量，这将促进其普遍性 通过使其数据收集方法的实施更加 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.