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. 2001 Aug 11;323(7308):324-7.
doi: 10.1136/bmj.323.7308.324.

Use of cumulative mortality data in patients with acute myocardial infarction for early detection of variation in clinical practice: observational study

R A Lawrance  1 , M F Dorsch, R J Sapsford, A F Mackintosh, D C Greenwood, B M Jackson, C Morrell, M B Robinson, A S Hall
Affiliations

Use of cumulative mortality data in patients with acute myocardial infarction for early detection of variation in clinical practice: observational study

R A Lawrance et al. BMJ. .

Abstract

Objectives: Use of cumulative mortality adjusted for case mix in patients with acute myocardial infarction for early detection of variation in clinical practice.

Design: Observational study.

Setting: 20 hospitals across the former Yorkshire region.

Participants: All 2153 consecutive patients with confirmed acute myocardial infarction identified during three months.

Main outcome measures: Variable life-adjusted displays showing cumulative differences between observed and expected mortality of patients; expected mortality calculated from risk model based on admission characteristics of age, heart rate, and systolic blood pressure.

Results: The performance of two individual hospitals over three months was examined as an example. One, the smallest district hospital in the region, had a series of 30 consecutive patients but had five more deaths than predicted. The variable life-adjusted display showed minimal variation from that predicted for the first 15 patients followed by a run of unexpectedly high mortality. The second example was the main tertiary referral centre for the region, which admitted 188 consecutive patients. The display showed a period of apparently poor performance followed by substantial improvement, where the plot rose steadily from a cumulative net lives saved of -4 to 7. These variations in patient outcome are unlikely to have been revealed during conventional audit practice.

Conclusions: Variable life-adjusted display has been integrated into surgical care as a graphical display of risk-adjusted survival for individual surgeons or centres. In combination with a simple risk model, it may have a role in monitoring performance and outcome in patients with acute myocardial infarction.

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Figures

Figure 1
Figure 1
Variable life-adjusted display of a small cottage hospital for a series of 30 consecutive patients with acute myocardial infarction. Predicted mortality was calculated by a validated risk score based on admission characteristics of age, systolic blood pressure, and heart rate
Figure 2
Figure 2
Variable life-adjusted display of a large teaching hospital and regional cardiac centre for a series of 188 consecutive patients with acute myocardial infarction. Predicted mortality was calculated by a simple risk score based on admission characteristics of age, systolic blood pressure, and heart rate
See this image and copyright information in PMC

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