Document Detail


Risk-adjustment model in health outcomes evaluation: a contribution to strengthen assessment towards quality improvement in interventional cardiology.
MedLine Citation:
PMID:  18621777     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: The aim of this study was to develop a risk adjustment model for major adverse cardiac and cerebrovascular events following percutaneous coronary intervention (PCI), using data from a national registry, and to highlight the use of the risk adjustment when we evaluate the quality of care in interventional cardiology. DESIGN: The STUDY DESIGN: was based on a Coorte study. Bivariate and multivariate logistic regression models were used to identify independent risk factors for these major adverse events. SETTING: A total of 19 hospitals from the Portuguese National Registry of Interventional Cardiology. PARTICIPANTS: Data from 10.641 consecutives procedures collected between June 30, 2003 and June 30, 2006. INTERVENTION: Build a risk adjustment model for these major adverse events, following percutaneous coronary intervention. MAIN OUTCOME MEASURE: Factors that were associated with major adverse cardiac and cerebrovascular events following percutaneous coronary intervention. RESULTS: The rate of in-hospital major adverse cardiac and cerebrovascular events was 1.9%. Factors associated with major adverse cardiac and cerebrovascular events included, among others: age >80 years (adjusted odds ratio = 3.91); female gender (1.72); and cardiogenic shock (6.05). Overall, a good discrimination was achieved with receiver operating characteristics curve = 0.84 and Hosmer-Lemeshow goodness of fit statistic across groups of risk was not significant (P = 0.18) indicating little departure from a perfect fit. CONCLUSIONS: These findings will represent an important contribution to quality and safety improvement and should help driving new research and innovative approaches to different subgroups of patients who have higher chances of having an adverse event or poorer outcomes following this intervention.
Authors:
Paulo Sousa; António Sousa Uva; Fausto Pinto;
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Publication Detail:
Type:  Journal Article     Date:  2008-07-11
Journal Detail:
Title:  International journal for quality in health care : journal of the International Society for Quality in Health Care / ISQua     Volume:  20     ISSN:  1353-4505     ISO Abbreviation:  Int J Qual Health Care     Publication Date:  2008 Oct 
Date Detail:
Created Date:  2008-09-12     Completed Date:  2009-01-14     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9434628     Medline TA:  Int J Qual Health Care     Country:  England    
Other Details:
Languages:  eng     Pagination:  324-30     Citation Subset:  IM    
Affiliation:
School of Health Technologies of Lisbon, Lisbon, Portugal. paulo.sousa@ensp.unl.pt
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Cardiology / standards*
Cardiovascular Diseases / surgery
Databases, Factual
Female
Humans
Male
Middle Aged
Models, Theoretical*
Outcome Assessment (Health Care)*
Portugal
Quality Assurance, Health Care / methods*
Regression Analysis
Retrospective Studies
Risk Adjustment*

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


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