Document Detail

Derivation and validation of a risk standardization model for benchmarking hospital performance for health-related quality of life outcomes after acute myocardial infarction.
MedLine Citation:
PMID:  24163068     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Before outcomes-based measures of quality can be used to compare and improve care, they must be risk-standardized to account for variations in patient characteristics. Despite the importance of health-related quality of life (HRQL) outcomes among patients with acute myocardial infarction (AMI), no risk-standardized models have been developed.
METHODS AND RESULTS: We assessed disease-specific HRQL using the Seattle Angina Questionnaire at baseline and 1 year later in 2693 unselected AMI patients from 24 hospitals enrolled in the Translational Research Investigating Underlying disparities in acute Myocardial infarction Patients' Health status (TRIUMPH) registry. Using 57 candidate sociodemographic, economic, and clinical variables present on admission, we developed a parsimonious, hierarchical linear regression model to predict HRQL. Eleven variables were independently associated with poor HRQL after AMI, including younger age, previous coronary artery bypass graft surgery, depressive symptoms, and financial difficulties (R(2)=20%). The model demonstrated excellent internal calibration and reasonable calibration in an independent sample of 1890 AMI patients in a separate registry, although the model slightly overpredicted HRQL scores in the higher deciles. Among the 24 TRIUMPH hospitals, 1-year unadjusted HRQL scores ranged from 67-89. After risk-standardization, HRQL score variability narrowed substantially (range=79-83), and the group of hospital performance (bottom 20%/middle 60%/top 20%) changed in 14 of the 24 hospitals (58% reclassification with risk-standardization).
CONCLUSIONS: In this predictive model for HRQL after AMI, we identified risk factors, including economic and psychological characteristics, associated with HRQL outcomes. Adjusting for these factors substantially altered the rankings of hospitals as compared with unadjusted comparisons. Using this model to compare risk-standardized HRQL outcomes across hospitals may identify processes of care that maximize this important patient-centered outcome.
Suzanne V Arnold; Frederick A Masoudi; John S Rumsfeld; Yan Li; Philip G Jones; John A Spertus
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Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, N.I.H., Extramural; Validation Studies     Date:  2013-10-25
Journal Detail:
Title:  Circulation     Volume:  129     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2014 Jan 
Date Detail:
Created Date:  2014-01-21     Completed Date:  2014-03-18     Revised Date:  2014-07-30    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  313-20     Citation Subset:  AIM; IM    
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MeSH Terms
Benchmarking / methods,  standards*
Middle Aged
Models, Statistical*
Myocardial Infarction* / epidemiology,  psychology,  therapy
Outcome and Process Assessment (Health Care) / methods,  standards*
Predictive Value of Tests
Quality of Life*
Registries / statistics & numerical data
Risk Assessment / methods,  standards
Risk Factors
Grant Support

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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