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PLoS One. 2017 Aug 4;12(8):e0182864. doi: 10.1371/journal.pone.0182864. eCollection 2017.

Cardiac arrest risk standardization using administrative data compared to registry data.

Author information

1
Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America.
2
Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America.
3
Department of Medicine, Division of Pulmonary and Critical Care Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America.
4
Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America.
5
Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada.
6
Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America.

Abstract

BACKGROUND:

Methods for comparing hospitals regarding cardiac arrest (CA) outcomes, vital for improving resuscitation performance, rely on data collected by cardiac arrest registries. However, most CA patients are treated at hospitals that do not participate in such registries. This study aimed to determine whether CA risk standardization modeling based on administrative data could perform as well as that based on registry data.

METHODS AND RESULTS:

Two risk standardization logistic regression models were developed using 2453 patients treated from 2000-2015 at three hospitals in an academic health system. Registry and administrative data were accessed for all patients. The outcome was death at hospital discharge. The registry model was considered the "gold standard" with which to compare the administrative model, using metrics including comparing areas under the curve, calibration curves, and Bland-Altman plots. The administrative risk standardization model had a c-statistic of 0.891 (95% CI: 0.876-0.905) compared to a registry c-statistic of 0.907 (95% CI: 0.895-0.919). When limited to only non-modifiable factors, the administrative model had a c-statistic of 0.818 (95% CI: 0.799-0.838) compared to a registry c-statistic of 0.810 (95% CI: 0.788-0.831). All models were well-calibrated. There was no significant difference between c-statistics of the models, providing evidence that valid risk standardization can be performed using administrative data.

CONCLUSIONS:

Risk standardization using administrative data performs comparably to standardization using registry data. This methodology represents a new tool that can enable opportunities to compare hospital performance in specific hospital systems or across the entire US in terms of survival after CA.

PMID:
28783754
PMCID:
PMC5544239
DOI:
10.1371/journal.pone.0182864
[Indexed for MEDLINE]
Free PMC Article

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