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Titolo:
Challenges in comparing risk-adjusted bypass surgery mortality results - Results from the Cooperative Cardiovascular Project
Autore:
Peterson, ED; DeLong, ER; Muhlbaier, LH; Rosen, AB; Buell, HE; Kiefe, CI; Kresowik, TF;
Indirizzi:
Duke Univ, Med Ctr, Duke Outcomes Res & Assessment Grp, Durham, NC 27710 USA Duke Univ Durham NC USA 27710 Res & Assessment Grp, Durham, NC 27710 USA Alabama Qual Assurance Fdn, Birmingham, AL USA Alabama Qual Assurance FdnBirmingham AL USA nce Fdn, Birmingham, AL USA Univ Alabama, Ctr Outcomes & Effectiveness Res & Educ, Birmingham, AL USA Univ Alabama Birmingham AL USA ectiveness Res & Educ, Birmingham, AL USA Iowa Fdn Med Care, W Des Moines, IA USA Iowa Fdn Med Care W Des Moines IAUSA Fdn Med Care, W Des Moines, IA USA
Titolo Testata:
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
fascicolo: 7, volume: 36, anno: 2000,
pagine: 2174 - 2184
SICI:
0735-1097(200012)36:7<2174:CICRBS>2.0.ZU;2-5
Fonte:
ISI
Lingua:
ENG
Soggetto:
OPEN-HEART-SURGERY; NEW-YORK-STATE; GRAFT-SURGERY; CARDIAC-SURGERY; HEALTH-CARE; QUALITY ASSESSMENT; OUTCOMES; STRATIFICATION; RATES; STATISTICS;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
45
Recensione:
Indirizzi per estratti:
Indirizzo: Peterson, ED Duke Univ, Med Ctr, Duke Outcomes Res & Assessment Grp, Box 3236, Durham, NC 27710 USA Duke Univ Box 3236 Durham NC USA 27710 , Durham, NC 27710 USA
Citazione:
E.D. Peterson et al., "Challenges in comparing risk-adjusted bypass surgery mortality results - Results from the Cooperative Cardiovascular Project", J AM COL C, 36(7), 2000, pp. 2174-2184

Abstract

OBJECTIVES We sought to evaluate the predictive accuracy of four bypass surgery mortality clinical risk models and to examine the extent to which hospitals' risk-adjusted surgical outcomes vary depending on which risk-adjustment method is applied. BACKGROUND Cardiovascular "report cards" often compare risk-adjusted surgical outcomes; however, it is unclear to what extent the risk-adjustment process itself may affect these metrics. METHODS As part of the Cooperative Cardiovascular Project's Pilot Revascularization Study, we compared the predictive accuracy of four bypass clinical risk models among 3,654 Medicare patients undergoing surgery at 28 hospitals in Alabama and Iowa. We also compared the agreement in hospital-level risk-adjusted bypass outcome performance ratings depending on which of the four risk models was applied. RESULTS Although the four risk models had similar discriminatory abilities(C-index, 0.71 to 0.74), certain models tended to overpredict mortality inhigher-risk patients. There was high correlation between a hospital's risk-adjusted mortality rates regardless of which of the four models was used (correlation between risk-adjusted rating, 0.93 to 0.97). In contrast, therewas limited agreement in which hospitals were identified as "performance outliers" depending on which risk-adjustment model was used and how outlier status was defined. CONCLUSIONS A hospital's risk-adjusted bypass surgery mortality rating, relative to its peers, was consistent regardless of the risk-adjustment modelapplied, supporting their use as a means of provider performance feedback. Designation of performance outliers, however, can vary significantly depending on the benchmark and methods used for this determination. (C) 2000 by the American College of Cardiology.

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Documento generato il 10/07/20 alle ore 11:38:37