Evaluating alternative risk-adjustment strategies for surgery - 25/08/11

Doi : 10.1016/j.amjsurg.2004.07.032

Adam Atherly, Ph.D. ^a,⁎ , Aaron S. Fink, M.D. ^b,^c, Darrell C. Campbell, M.D. ^d, Robert M. Mentzer, M.D. ^e, William Henderson, Ph.D. ^f, Shukri Khuri, M.D. ^g,^h, Steven D. Culler, Ph.D. ^a
^a Department of Health Policy and Management, Rollins School of Public Health, Emory University, 1518 Clifton Rd. N.E., Atlanta, GA 30322, USA
^b Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
^c Surgical Service, Atlanta VA Medical Center, Atlanta, GA, USA
^d Department of Surgery and Office of Clinical Affairs, University of Michigan Medical Center, Ann Arbor, MI, USA
^e Department of Surgery, University of Kentucky, Lexington, KY, USA
^f Colorado Health Outcomes Program, University of Colorado, Denver, CO, USA
^g Department of Surgery, West Roxbury VAMC, West Roxbury, MA, USA
^h Harvard Medical School, Boston, MA, USA

^*Corresponding author. Tel.: +1-404-727-1175; fax: +1-404-727-9198.

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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Keywords : Mortality, National Surgical Quality Improvement Program, Risk adjustment, Surgical outcomes

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Vol 188 - N° 5

P. 566-570 - novembre 2004 Retour au numéro

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Evaluating alternative risk-adjustment strategies for surgery - 25/08/11

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