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Present-at-admission diagnoses improved mortality risk adjustment among acute myocardial infarction patients.

Abstract：

OBJECTIVE:Hospital mortality outcomes for acute myocardial infarction (AMI) patients are a focus of quality improvement programs conducted by government agencies. AMI mortality risk-adjustment models using administrative data typically adjust for baseline differences in mortality risk with a limited set of common and definite comorbidities. In this study, we present an AMI mortality risk-adjustment model that adjusts for comorbid disease and for AMI severity using information from secondary diagnoses reported as present at admission for California hospital patients. STUDY DESIGN AND SETTING:AMI patients were selected from California hospital administrative data for 1996 through 1999 according to criteria used by the California Hospital Outcomes Project Report on Heart Attack Outcomes, a state-mandated public report that compares hospital mortality outcomes. We compared results for the new model to two mortality risk-adjustment models used to assess hospital AMI mortality outcomes by the state of California, and to two other models used in prior research. RESULTS:The model using present-at-admission diagnoses obtained substantially better discrimination between predicted survival and inpatient death than the other models we considered. CONCLUSION:AMI mortality risk-adjustment methods can be meaningfully improved using present-at-admission diagnoses to identify comorbid disease and conditions related closely to AMI.

journal_name

J Clin Epidemiol

journal_title

Journal of clinical epidemiology

authors

Stukenborg GJ,Wagner DP,Harrell FE Jr,Oliver MN,Heim SW,Price AL,Han CK,Wolf AM,Connors AF Jr

doi

10.1016/j.jclinepi.2006.05.014

subject

Has Abstract

pub_date

2007-02-01 00:00:00

pages

142-54

issue

2

eissn

0895-4356

issn

1878-5921

pii

S0895-4356(06)00286-1

journal_volume

60

pub_type

杂志文章

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