Development and Validation of an Agency for Healthcare Research and Quality Indicator for Mortality After Congenital Heart Surgery Harmonized With Risk Adjustment for Congenital Heart Surgery (RACHS‐1) Methodology
BackgroundThe National Quality Forum previously approved a quality indicator for mortality after congenital heart surgery developed by the Agency for Healthcare Research and Quality (AHRQ). Several parameters of the validated Risk Adjustment for Congenital Heart Surgery (RACHS‐1) method were include...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2016-05-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.115.003028 |
| _version_ | 1811334227705200640 |
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| author | Kathy J. Jenkins Jennifer Koch Kupiec Pamela L. Owens Patrick S. Romano Jeffrey J. Geppert Kimberlee Gauvreau |
| author_facet | Kathy J. Jenkins Jennifer Koch Kupiec Pamela L. Owens Patrick S. Romano Jeffrey J. Geppert Kimberlee Gauvreau |
| author_sort | Kathy J. Jenkins |
| collection | DOAJ |
| description | BackgroundThe National Quality Forum previously approved a quality indicator for mortality after congenital heart surgery developed by the Agency for Healthcare Research and Quality (AHRQ). Several parameters of the validated Risk Adjustment for Congenital Heart Surgery (RACHS‐1) method were included, but others differed. As part of the National Quality Forum endorsement maintenance process, developers were asked to harmonize the 2 methodologies. Methods and ResultsParameters that were identical between the 2 methods were retained. AHRQ's Healthcare Cost and Utilization Project State Inpatient Databases (SID) 2008 were used to select optimal parameters where differences existed, with a goal to maximize model performance and face validity. Inclusion criteria were not changed and included all discharges for patients <18 years with International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes for congenital heart surgery or nonspecific heart surgery combined with congenital heart disease diagnosis codes. The final model includes procedure risk group, age (0–28 days, 29–90 days, 91–364 days, 1–17 years), low birth weight (500–2499 g), other congenital anomalies (Clinical Classifications Software 217, except for 758.xx), multiple procedures, and transfer‐in status. Among 17 945 eligible cases in the SID 2008, the c statistic for model performance was 0.82. In the SID 2013 validation data set, the c statistic was 0.82. Risk‐adjusted mortality rates by center ranged from 0.9% to 4.1% (5th–95th percentile). ConclusionsCongenital heart surgery programs can now obtain national benchmarking reports by applying AHRQ Quality Indicator software to hospital administrative data, based on the harmonized RACHS‐1 method, with high discrimination and face validity. |
| first_indexed | 2024-04-13T17:04:45Z |
| format | Article |
| id | doaj.art-f7e98d4d87c04d5d85464e3bac7b95cd |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-13T17:04:45Z |
| publishDate | 2016-05-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-f7e98d4d87c04d5d85464e3bac7b95cd2022-12-22T02:38:32ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802016-05-015510.1161/JAHA.115.003028Development and Validation of an Agency for Healthcare Research and Quality Indicator for Mortality After Congenital Heart Surgery Harmonized With Risk Adjustment for Congenital Heart Surgery (RACHS‐1) MethodologyKathy J. Jenkins0Jennifer Koch Kupiec1Pamela L. Owens2Patrick S. Romano3Jeffrey J. Geppert4Kimberlee Gauvreau5Boston Children's Hospital, Boston, MABoston Children's Hospital, Boston, MAAgency for Healthcare Research and Quality, Rockville, MDUniversity of California Davis School of Medicine, Sacramento, CABattelle Memorial Institute, Columbus, OHBoston Children's Hospital, Boston, MABackgroundThe National Quality Forum previously approved a quality indicator for mortality after congenital heart surgery developed by the Agency for Healthcare Research and Quality (AHRQ). Several parameters of the validated Risk Adjustment for Congenital Heart Surgery (RACHS‐1) method were included, but others differed. As part of the National Quality Forum endorsement maintenance process, developers were asked to harmonize the 2 methodologies. Methods and ResultsParameters that were identical between the 2 methods were retained. AHRQ's Healthcare Cost and Utilization Project State Inpatient Databases (SID) 2008 were used to select optimal parameters where differences existed, with a goal to maximize model performance and face validity. Inclusion criteria were not changed and included all discharges for patients <18 years with International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes for congenital heart surgery or nonspecific heart surgery combined with congenital heart disease diagnosis codes. The final model includes procedure risk group, age (0–28 days, 29–90 days, 91–364 days, 1–17 years), low birth weight (500–2499 g), other congenital anomalies (Clinical Classifications Software 217, except for 758.xx), multiple procedures, and transfer‐in status. Among 17 945 eligible cases in the SID 2008, the c statistic for model performance was 0.82. In the SID 2013 validation data set, the c statistic was 0.82. Risk‐adjusted mortality rates by center ranged from 0.9% to 4.1% (5th–95th percentile). ConclusionsCongenital heart surgery programs can now obtain national benchmarking reports by applying AHRQ Quality Indicator software to hospital administrative data, based on the harmonized RACHS‐1 method, with high discrimination and face validity.https://www.ahajournals.org/doi/10.1161/JAHA.115.003028congenital heart defectsmortalitypediatricsrisk factors |
| spellingShingle | Kathy J. Jenkins Jennifer Koch Kupiec Pamela L. Owens Patrick S. Romano Jeffrey J. Geppert Kimberlee Gauvreau Development and Validation of an Agency for Healthcare Research and Quality Indicator for Mortality After Congenital Heart Surgery Harmonized With Risk Adjustment for Congenital Heart Surgery (RACHS‐1) Methodology Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease congenital heart defects mortality pediatrics risk factors |
| title | Development and Validation of an Agency for Healthcare Research and Quality Indicator for Mortality After Congenital Heart Surgery Harmonized With Risk Adjustment for Congenital Heart Surgery (RACHS‐1) Methodology |
| title_full | Development and Validation of an Agency for Healthcare Research and Quality Indicator for Mortality After Congenital Heart Surgery Harmonized With Risk Adjustment for Congenital Heart Surgery (RACHS‐1) Methodology |
| title_fullStr | Development and Validation of an Agency for Healthcare Research and Quality Indicator for Mortality After Congenital Heart Surgery Harmonized With Risk Adjustment for Congenital Heart Surgery (RACHS‐1) Methodology |
| title_full_unstemmed | Development and Validation of an Agency for Healthcare Research and Quality Indicator for Mortality After Congenital Heart Surgery Harmonized With Risk Adjustment for Congenital Heart Surgery (RACHS‐1) Methodology |
| title_short | Development and Validation of an Agency for Healthcare Research and Quality Indicator for Mortality After Congenital Heart Surgery Harmonized With Risk Adjustment for Congenital Heart Surgery (RACHS‐1) Methodology |
| title_sort | development and validation of an agency for healthcare research and quality indicator for mortality after congenital heart surgery harmonized with risk adjustment for congenital heart surgery rachs 1 methodology |
| topic | congenital heart defects mortality pediatrics risk factors |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.115.003028 |
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