Evaluating alternative risk-adjustment strategies for surgery.
Am J Surg
; 188(5): 566-70, 2004 Nov.
Article
em En
| MEDLINE
| ID: mdl-15546571
ABSTRACT
BACKGROUND:
Comparison of institutional health care outcomes requires risk adjustment. Risk-adjustment methodology may influence the results of such comparisons.METHODS:
We compared 3 risk-adjustment methodologies used to assess the quality of surgical care. Nurse reviewers abstracted data from a continuous sample of 2,167 surgical patients at 3 academic institutions. One risk adjustor was based on medical record data (National Surgical Quality Improvement Program [NSQIP]) whereas the other 2, the DxCG and Charlson Comorbidity Index (CCI), primarily used International Classification of Disease-9 (ICD-9) codes. Risk-assessment scores from the 3 systems were compared with each other and with mortality.RESULTS:
Substantial disagreement was found in the risk assessment calculated by the 3 methodologies. Although there was a weak association between the CCI and DxCG, neither correlated well with the NSQIP. The NSQIP was best able to predict mortality, followed by the DxCG and CCI.CONCLUSION:
In surgical patients, different risk-adjustment methodologies afford divergent estimates of mortality risk.
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Base de dados:
MEDLINE
Assunto principal:
Garantia da Qualidade dos Cuidados de Saúde
/
Centro Cirúrgico Hospitalar
/
Procedimentos Cirúrgicos Operatórios
/
Risco Ajustado
Tipo de estudo:
Diagnostic_studies
/
Etiology_studies
/
Evaluation_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Female
/
Humans
/
Male
País como assunto:
America do norte
Idioma:
En
Ano de publicação:
2004
Tipo de documento:
Article