连续监测风险调整结局：超额死亡与拯救生命。

Continuous Monitoring of Risk-Adjusted Outcomes: Excess Deaths vs Lives Saved.

机构信息

Center for Cardiovascular Analytics, Research and Data Science (CARDS), Providence Heart Institute, Providence St. Joseph Health, Portland, Oregon.

出版信息

Ann Thorac Surg. 2021 Aug;112(2):368-372. doi: 10.1016/j.athoracsur.2021.03.110. Epub 2021 Apr 24.

DOI:10.1016/j.athoracsur.2021.03.110

PMID:33905732

Abstract

Reporting of risk-adjusted surgical outcomes is commonly used to compare providers and track changes over time. Preferred graphical methods use the relationship of the observed to the expected values of outcome events, including their ratio (O/E), and the cumulative sum (CUSUM) of their differences over time, called Risk-Adjusted CUSUM (RA-CUSUM) or Variable Life Adjusted Display (VLAD). We demonstrate these methods using operative mortality data for 7255 isolated coronary artery bypass graft patients from January 2014 to June 2017. RA-CUSUM and VLAD are excellent techniques to display risk-adjusted outcomes and, unlike O/E, can provide continuous monitoring as performance varies over time.

摘要

报告风险调整后的手术结果通常用于比较提供者并跟踪随时间的变化。首选的图形方法使用观察到的结果事件的预期值的关系，包括它们的比值（O/E）以及它们随时间的差异的累积和（CUSUM），称为风险调整的 CUSUM（RA-CUSUM）或变量生命调整显示（VLAD）。我们使用 2014 年 1 月至 2017 年 6 月期间 7255 例孤立性冠状动脉旁路移植患者的手术死亡率数据来演示这些方法。RA-CUSUM 和 VLAD 是显示风险调整结果的优秀技术，与 O/E 不同，它们可以随着性能随时间的变化而提供连续监测。