Τίτλος:
A European benchmarking system to evaluate in-hospital mortality rates
in acute coronary syndrome: The EURHOBOP project
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Background: Hospital performance models in acute myocardial infarction
(AMI) are useful to assess patient management. While models are
available for individual countries, mainly US, cross-European
performance models are lacking. Thus, we aimed to develop a system to
benchmark European hospitals in AMI and percutaneous coronary
intervention (PCI), based on predicted in-hospital mortality.
Methods and results: We used the EURopean HOspital Benchmarking by
Outcomes in ACS Processes (EURHOBOP) cohort to develop the models, which
included 11,631 AMI patients and 8276 acute coronary syndrome (ACS)
patients who underwent PCI. Models were validated with a cohort of
55,955 European ACS patients. Multilevel logistic regression was used to
predict in-hospital mortality in European hospitals for AMI and PCI.
Administrative and clinical models were constructed with patient-and
hospital-level covariates, as well as hospital-and country-based random
effects. Internal cross-validation and external validation showed good
discrimination at the patient level and good calibration at the hospital
level, based on the C-index (0.736-0.819) and the concordance
correlation coefficient (55.4%-80.3%). Mortality ratios (MRs) showed
excellent concordance between administrative and clinical models (97.5%
for AMI and 91.6% for PCI). Exclusion of transfers and hospital stays
<= 1 day did not affect in-hospital mortality prediction in sensitivity
analyses, as shown by MR concordance (80.9%-85.4%). Models were used
to develop a benchmarking system to compare in-hospital mortality rates
of European hospitals with similar characteristics.
Conclusions: The developed system, based on the EURHOBOP models, is a
simple and reliable tool to compare in hospital mortality rates between
European hospitals in AMI and PCI. (C) 2015 Elsevier Ireland Ltd. All
rights reserved.
Συγγραφείς:
Degano, Irene R.
Subirana, Isaac
Torre, Marina
Grau, Maria
and Vila, Joan
Fusco, Danilo
Kirchberger, Inge
Ferrieres,
Jean
Malmivaara, Antti
Azevedo, Ana
Meisinger, Christa and
Bongard, Vanina
Farmakis, Dimitros
Davoli, Marina
Hakkinen,
Unto
Araujo, Carla
Lekakis, John
Elosua, Roberto and
Marrugat, Jaume
EURHOBOP Investigators
Περιοδικό:
International Journal of Cardiology
Εκδότης:
Elsevier Ireland Ltd
Λέξεις-κλειδιά:
Benchmarking; Hospital performance; Acute myocardial infarction;
Percutaneous coronary intervention; In-hospital mortality
DOI:
10.1016/j.ijcard.2015.01.019
