(Circulation. 1999;99:2986-2992.)
© 1999 American Heart Association, Inc.
Clinical Investigation and Reports |
Comparing AMI Mortality Among Hospitals in Patients 65 Years of Age and Older
Evaluating Methods of Risk Adjustment
From the Sections of Cardiovascular Medicine, Department of Medicine (H.K., J.C., M.R.) and Chronic Disease Epidemiology, Department of Epidemiology and Public Health (H.K.), Yale University School of Medicine, New Haven, Conn; the Yale-New Haven Hospital Center for Outcomes Research and Evaluation, New Haven, Conn (H.K., M.R., Y.W., Y.-T.C.); Qualidigm, Middletown, Conn (H.K., M.R.); and the Health Care Financing Administration, Baltimore, Md (T.M.).
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
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.
Key Words: myocardial infarction • prognosis • mortality • risk factors • elderly
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