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Comparative Study
. 2013 Aug 13;62(7):601-9.
doi: 10.1016/j.jacc.2013.05.051. Epub 2013 Jun 13.

Risk-standardizing survival for in-hospital cardiac arrest to facilitate hospital comparisons

Paul S Chan  1 , Robert A Berg, John A Spertus, Lee H Schwamm, Deepak L Bhatt, Gregg C Fonarow, Paul A Heidenreich, Brahmajee K Nallamothu, Fengming Tang, Raina M Merchant; AHA GWTG-Resuscitation Investigators
Affiliations
Comparative Study

Risk-standardizing survival for in-hospital cardiac arrest to facilitate hospital comparisons

Paul S Chan et al. J Am Coll Cardiol. .

Abstract

Objectives: The purpose of this study is to develop a method for risk-standardizing hospital survival after cardiac arrest.

Background: A foundation with which hospitals can improve quality is to be able to benchmark their risk-adjusted performance against other hospitals, something that cannot currently be done for survival after in-hospital cardiac arrest.

Methods: Within the Get With The Guidelines (GWTG)-Resuscitation registry, we identified 48,841 patients admitted between 2007 and 2010 with an in-hospital cardiac arrest. Using hierarchical logistic regression, we derived and validated a model for survival to hospital discharge and calculated risk-standardized survival rates (RSSRs) for 272 hospitals with at least 10 cardiac arrest cases.

Results: The survival rate was 21.0% and 21.2% for the derivation and validation cohorts, respectively. The model had good discrimination (C-statistic 0.74) and excellent calibration. Eighteen variables were associated with survival to discharge, and a parsimonious model contained 9 variables with minimal change in model discrimination. Before risk adjustment, the median hospital survival rate was 20% (interquartile range: 14% to 26%), with a wide range (0% to 85%). After adjustment, the distribution of RSSRs was substantially narrower: median of 21% (interquartile range: 19% to 23%; range 11% to 35%). More than half (143 [52.6%]) of hospitals had at least a 10% positive or negative absolute change in percentile rank after risk standardization, and 50 (23.2%) had a ≥20% absolute change in percentile rank.

Conclusions: We have derived and validated a model to risk-standardize hospital rates of survival for in-hospital cardiac arrest. Use of this model can support efforts to compare hospitals in resuscitation outcomes as a foundation for quality assessment and improvement.

Keywords: AHA; American Heart Association; DNR; GWTG; Get With The Guidelines; cardiac arrest; do not resuscitate; risk adjustment; variation in care.

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Figures

Figure 1
Figure 1. Distribution of Unadjusted and Risk-Standardized Hospital Survival Rates for In-Hospital Cardiac Arrest
(A) Observed hospital rates: the number of hospitals for each range of survival rates is displayed. A total of 276 hospitals with ≥10 in-hospital cardiac arrest cases were evaluated. (B) Risk-standardized hospital rates: the number of hospitals for each range of survival rates is displayed. A total of 276 hospitals with ≥10 in-hospital cardiac arrest cases was evaluated.
Figure 2
Figure 2. Hospital Change in Absolute Rank Percentile After Risk Standardization
The change in a hospital’s percentile rank in survival rates for in-hospital cardiac arrest after accounting for patient case-mix is depicted. Of 272 hospitals, 143 (52.6%) had at least a 10% positive or negative absolute change in percentile rank after risk standardization, and 50 hospitals (23.2%) had a substantial ≥20% absolute change in percentile rank.
See this image and copyright information in PMC

References

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