Department of Pediatrics, Rush University Medical Center, Chicago, IL, USA.
Pediatr Crit Care Med. 2013 Jun;14(5):491-8. doi: 10.1097/PCC.0b013e31828a87ea.
To evaluate the performance of risk-adjustment models from the University HealthSystem Consortium and the Agency for Healthcare Research Quality on an administrative dataset for children undergoing congenital cardiac surgery.
Retrospective cross-sectional cohort analysis.
Multi-institutional database of administrative data provided by the University HealthSystem Consortium.
Children whose discharge diagnosis had an associated cardiac surgical procedure.
None.
The performance of two risk-adjustment modeling schemata was measured in terms of discrimination and calibration, and receiver operating characteristic curves were compared. Model calibration was assessed using the Hosmer-Lemeshow goodness-of-fit test. A total of 19,436 patients were included in the analysis with 816 deaths and an unadjusted overall mortality rate of 4.2%. The University HealthSystem Consortium models applied to the entire population resulted in an area under the curve = 0.73, and by comparison, the Agency for Healthcare Research Quality risk-adjustment model revealed area under the curve = 0.86. The risk-adjustment model of the University HealthSystem Consortium subgroup of Circulatory System Major Diagnostic Category 5 showed better performance with area under the curve = 0.81. Calibration using the Hosmer-Lemeshow test failed to show good agreement between the predicted and actual outcomes across the University HealthSystem Consortium mortality risk groups with an overall standardized mortality ratio of 1.2 (95% CI, 1.1-1.3; p < 0.0001) and poor predictive ability for the highest risk group, with a nearly 1.5-fold overprediction of death. The Agency for Healthcare Research Quality model shared similar calibration results with an overall standardized mortality ratio of 1.6 (95% CI, 1.5-1.7; p < 0.0001) and a nearly two-fold underprediction of death in the highest risk group.
Administrative data can be used to create risk-adjustment models in the congenital cardiac surgery population. Risk-adjustment models generated from administrative data may represent an attractive addition to clinically derived models in pediatric congenital cardiac surgery patients and should be considered for use either alone or in combination with clinical data in future analyses where mortality is a measure of performance and quality.
评估大学健康联盟（University HealthSystem Consortium，UHC）和医疗保健研究质量机构（Agency for Healthcare Research Quality，AHRQ）的风险调整模型在接受先天性心脏手术的儿童的行政数据集上的表现。
回顾性横断面队列分析。
UHC 提供的行政数据多机构数据库。
出院诊断与心脏手术相关的儿童。
无。
使用区分度和校准度来衡量两种风险调整建模方案的性能，并比较接收器工作特征曲线。使用 Hosmer-Lemeshow 拟合优度检验评估模型校准。共纳入 19436 例患者，其中 816 例死亡，未调整的总死亡率为 4.2%。UHC 模型应用于整个人群的曲线下面积为 0.73，相比之下，AHRQ 风险调整模型的曲线下面积为 0.86。UHC 循环系统主要诊断类别 5 亚组的风险调整模型表现更好，曲线下面积为 0.81。Hosmer-Lemeshow 检验显示，UHC 死亡率风险组的预测结果与实际结果之间校准不一致，标准化死亡率比总体为 1.2（95%置信区间，1.1-1.3；p < 0.0001），最高风险组的预测能力较差，死亡率几乎高估了 1.5 倍。AHRQ 模型的校准结果相似，标准化死亡率比总体为 1.6（95%置信区间，1.5-1.7；p < 0.0001），最高风险组的死亡率几乎低估了 2 倍。
行政数据可用于创建先天性心脏手术人群的风险调整模型。从行政数据中生成的风险调整模型可能是儿科先天性心脏手术患者临床衍生模型的一个有吸引力的补充，应考虑在未来的分析中单独使用或与临床数据结合使用，其中死亡率是绩效和质量的衡量标准。
