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Risk adjustment data validation audit

Tameka McFadyen, Jennifer Tindall, John Wiggers, Melanie Kingsland, Shauna Sherker, Karen Gillham, Bosco Rowland, Rachael Heaton, Christophe Lecathelinais, Luke Wolfenden
INTRODUCTION AND AIMS: Those involved in organised sport have a high risk of excessive alcohol consumption and alcohol-related harm, the implementation of alcohol management practices have been proven to reduce these risks. Measuring alcohol management practice implementation by sporting clubs is impeded by a lack of valid tools. The aim of this study was to determine the validity of online self-report of alcohol-management practices by community football clubs via comparison with observational methods...
June 7, 2018: Drug and Alcohol Review
A Cook, T Osler, L Glance, F Lecky, O Bouamra, J Weddle, B Gross, J Ward, F O Moore, F Rogers, D Hosmer
BACKGROUND: The Trauma Audit and Research Network (TARN) in the UK publicly reports hospital performance in the management of trauma. The TARN risk adjustment model uses a fractional polynomial transformation of the Injury Severity Score (ISS) as the measure of anatomical injury severity. The Trauma Mortality Prediction Model (TMPM) is an alternative to ISS; this study compared the anatomical injury components of the TARN model with the TMPM. METHODS: Data from the National Trauma Data Bank for 2011-2015 were analysed...
April 2018: British Journal of Surgery
Marek Psota, Piotr Bandosz, Eva Gonçalvesová, Mária Avdičová, Mária Bucek Pšenková, Martin Studenčan, Jarmila Pekarčíková, Simon Capewell, Martin O'Flaherty
OBJECTIVE: Between the years 1993 and 2008, mortality rates from coronary heart disease (CHD) in the Slovak Republic have decreased by almost one quarter. However, this was a smaller decline than in neighbouring countries. The aim of this modelling study was therefore to quantify the contributions of risk factor changes and the use of evidence-based medical therapies to the CHD mortality decline between 1993 and 2008. METHODS: We identified, obtained and scrutinised the data required for the model...
2018: PloS One
Julian Karres, Noera Kieviet, Jan-Peter Eerenberg, Bart C Vrouenraets
OBJECTIVES: Early mortality after hip fracture surgery is high and preoperative risk assessment for the individual patient is challenging. A risk model could identify patients in need of more intensive perioperative care, provide insight in the prognosis, and allow for risk adjustment in audits. This study aimed to develop and validate a risk prediction model for 30-day mortality after hip fracture surgery: the Hip fracture Estimator of Mortality Amsterdam (HEMA). METHODS: Data on 1050 consecutive patients undergoing hip fracture surgery between 2004 and 2010 were retrospectively collected and randomly split into a development cohort (746 patients) and validation cohort (304 patients)...
January 2018: Journal of Orthopaedic Trauma
Mitchell J Magee
Administrative data are less accurate and relevant than specialty-specific, procedure-specific, risk-adjusted data collected in voluntary registries such as the Society of Thoracic Surgeons-General Thoracic Surgery Database (GTSD). Voluntary clinical databases must be proven accurate and complete before they are accepted as credible information sources. With substantial growth of the GTSD, an annual audit was initiated in 2010 to assess the completeness, accuracy, and quality of the data collected. The audit process is essential in validating data quality and adding credibility and value to volunteer clinical registries...
August 2017: Thoracic Surgery Clinics
D Tighe, I Sassoon, M McGurk
INTRODUCTION In 2013 all UK surgical specialties, with the exception of head and neck surgery, published outcome data adjusted for case mix for indicator operations. This paper reports a pilot study to validate a previously published risk adjustment score on patients from separate UK cancer centres. METHODS A case note audit was performed of 1,075 patients undergoing 1,218 operations for head and neck squamous cell carcinoma under general anaesthesia in 4 surgical centres. A logistic regression equation predicting for all complications, previously validated internally at sites A-C, was tested on a fourth external validation sample (site D, 172 operations) using receiver operating characteristic curves, Hosmer-Lemeshow goodness of fit analysis and Brier scores...
April 2017: Annals of the Royal College of Surgeons of England
Alessandro Brunelli, Michele Salati, Gaetano Rocco, Gonzalo Varela, Dirk Van Raemdonck, Herbert Decaluwe, Pierre Emmanuel Falcoz
Objectives: To develop models of 30-day mortality and cardiopulmonary morbidity from data on anatomic lung resections deposited in the European Society of Thoracic Surgeons (ESTS) database. Methods: Retrospective analysis of 47 960 anatomic lung resections from the ESTS database (July 2007-August 2015) (36 376 lobectomies, 2296 bilobectomies, 5040 pneumonectomies and 4248 segmentectomies). Logistic regression analyses were used to test the association between baseline and surgical variables and morbidity or mortality...
March 1, 2017: European Journal of Cardio-thoracic Surgery
Katherine S L McAllister, Peter F Ludman, William Hulme, Mark A de Belder, Rodney Stables, Saqib Chowdhary, Mamas A Mamas, Matthew Sperrin, Iain E Buchan
BACKGROUND: The current risk model for percutaneous coronary intervention (PCI) in the UK is based on outcomes of patients treated in a different era of interventional cardiology. This study aimed to create a new model, based on a contemporary cohort of PCI treated patients, which would: predict 30 day mortality; provide good discrimination; and be well calibrated across a broad risk-spectrum. METHODS AND RESULTS: The model was derived from a training dataset of 336,433 PCI cases carried out between 2007 and 2011 in England and Wales, with 30 day mortality provided by record linkage...
May 1, 2016: International Journal of Cardiology
T C Marufu, S M White, R Griffiths, S R Moonesinghe, I K Moppett
The care of the elderly with hip fractures and their outcomes might be improved with resources targeted by the accurate calculation of risks of mortality and morbidity. We used a multicentre national dataset to evaluate and recalibrate the Nottingham Hip Fracture Score and Surgical Outcome Risk Tool. We split 9,017 hip fracture cases from the Anaesthesia Sprint Audit of Practice into derivation and validation data sets and used logistic regression to derive new model co-efficients for death at 30 postoperative days...
May 2016: Anaesthesia
Kannayiram Alagiakrishnan, Patricia Wilson, Cheryl A Sadowski, Darryl Rolfson, Mark Ballermann, Allen Ausford, Karla Vermeer, Kunal Mohindra, Jacques Romney, Robert S Hayward
BACKGROUND: Elderly people (aged 65 years or more) are at increased risk of polypharmacy (five or more medications), inappropriate medication use, and associated increased health care costs. The use of clinical decision support (CDS) within an electronic medical record (EMR) could improve medication safety. METHODS: Participatory action research methods were applied to preproduction design and development and postproduction optimization of an EMR-embedded CDS implementation of the Beers' Criteria for medication management and the Cockcroft-Gault formula for estimating glomerular filtration rates (GFR)...
2016: Clinical Interventions in Aging
Deb Sanjay Nag
Emergency laparotomy is the commonest emergency surgical procedure in most hospitals and includes over 400 diverse surgical procedures. Despite the evolution of medicine and surgical practices, the mortality in patients needing emergency laparotomy remains abnormally high. Although surgical risk assessment first started with the ASA Physical Status score in 1941, efforts to find an ideal scoring system that accurately estimates the risk of mortality, continues till today. While many scoring systems have been developed, no single scoring system has been validated across multiple centers and geographical locations...
December 2015: BioMedicine
C Fischer, H Lingsma, R Hardwick, D A Cromwell, E Steyerberg, O Groene
BACKGROUND: Outcomes for oesophagogastric cancer surgery are compared with the aim of benchmarking quality of care. Adjusting for patient characteristics is crucial to avoid biased comparisons between providers. The study objective was to develop a case-mix adjustment model for comparing 30- and 90-day mortality and anastomotic leakage rates after oesophagogastric cancer resections. METHODS: The study reviewed existing models, considered expert opinion and examined audit data in order to select predictors that were consequently used to develop a case-mix adjustment model for the National Oesophago-Gastric Cancer Audit, covering England and Wales...
January 2016: British Journal of Surgery
Lindsay E Calderon, Kevin T Kavanagh, Mara K Rice
Catheter-associated urinary tract infections (CAUTIs) occur in 290,000 US hospital patients annually, with an estimated cost of $290 million. Two different measurement systems are being used to track the US health care system's performance in lowering the rate of CAUTIs. Since 2010, the Agency for Healthcare Research and Quality (AHRQ) metric has shown a 28.2% decrease in CAUTI, whereas the Centers for Disease Control and Prevention metric has shown a 3%-6% increase in CAUTI since 2009. Differences in data acquisition and the definition of the denominator may explain this discrepancy...
October 1, 2015: American Journal of Infection Control
Titilayo O Adegboyega, Jeffrey Landercasper, Jared H Linebarger, Jeanne M Johnson, Jeremiah J Andersen, Leah L Dietrich, Collin D Driscoll, Meghana Raghavendra, Anusha R Madadi, Mohammed Al-Hamadani, Choua A Vang, Kristen A Marcou, Jane Hudak, Ronald S Go
BACKGROUND: Variations exist in compliance with NCCN Guidelines. Prior reports of adherence to NCCN Guidelines contain limitations because of lack of contemporary review and incomplete listing of reasons for noncompliance. PURPOSE: To assess institutional compliance and assist national quality improvement strategies through identifying valid reasons for noncompliance. METHODS: Compliance with NCCN Guidelines was recorded prospectively using electronic synoptic templates for patients with newly diagnosed breast cancer treated at a single institution between January 2010 and December 2011...
February 2015: Journal of the National Comprehensive Cancer Network: JNCCN
David A Harrison, Nazir I Lone, Catriona Haddow, Moranne MacGillivray, Angela Khan, Brian Cook, Kathryn M Rowan
BACKGROUND: Risk prediction models are used in critical care for risk stratification, summarising and communicating risk, supporting clinical decision-making and benchmarking performance. However, they require validation before they can be used with confidence, ideally using independently collected data from a different source to that used to develop the model. The aim of this study was to validate the Intensive Care National Audit & Research Centre (ICNARC) model using independently collected data from critical care units in Scotland...
2014: BMC Anesthesiology
P D Radford, L F Derbyshire, J Shalhoub, J E F Fitzgerald
Government-mandated publication of named surgeon-specific outcome data (SSD) has recently been introduced across nine surgical speciality areas in England. This move is the first time that such national data has been released in any country, and it promises to provide a significant advancement in health service transparency. Data is derived from nine preexisting national surgical audit databases. However, eight of these were not originally designed for this purpose, and there is considerable controversy surrounding data quality, risk adjustment, patient use and interpretation, and surgeons' subsequent case selection...
January 2015: International Journal of Surgery
Sebastian Wutzler, Marc Maegele, Arasch Wafaisade, Hendrik Wyen, Ingo Marzi, Rolf Lefering
Scoring systems commonly attempt to reduce complex clinical situations into one-dimensional values by objectively valuing and combining a variety of clinical aspects. The aim is to allow for a comparison of selected patients or cohorts. To appreciate the true value of scoring systems in patients with multiple injuries it is necessary to understand the different purposes of quantifying the severity of specific injuries and overall trauma load, being: (1) clinical decision making; (2) triage; (3) planning of trauma systems and resources; (4) epidemiological and clinical research; (5) evaluation of outcome and trauma systems, including quality assessment; and (6) estimation of costs and allocation of resources...
October 2014: Injury
Shelley Reid, Barbara Bajuk, Kei Lui, Elizabeth A Sullivan
AIMS: This article compares the severity of illness scoring systems clinical risk index for babies (CRIB)-II and score for neonatal acute physiology with perinatal extension (SNAPPE)-II for discriminatory ability and goodness of fit in the same cohort of babies of less than 32 weeks gestation and aims to provide validation in the Australian population. METHODS: CRIB-II and SNAPPE-II scores were collected on the same cohort of preterm infants born within a 2-year period, 2003 and 2004...
September 30, 2014: Journal of Paediatrics and Child Health
S W Grant, G L Hickey, E D Carlson, C N McCollum
OBJECTIVE/BACKGROUND: A number of contemporary risk prediction models for mortality following elective abdominal aortic aneurysm (AAA) repair have been developed. Before a model is used either in clinical practice or to risk-adjust surgical outcome data it is important that its performance is assessed in external validation studies. METHODS: The British Aneurysm Repair (BAR) score, Medicare, and Vascular Governance North West (VGNW) models were validated using an independent prospectively collected sample of multicentre clinical audit data...
July 2014: European Journal of Vascular and Endovascular Surgery
David A Harrison, Krishna Patel, Edel Nixon, Jasmeet Soar, Gary B Smith, Carl Gwinnutt, Jerry P Nolan, Kathryn M Rowan
AIM: The National Cardiac Arrest Audit (NCAA) is the UK national clinical audit for in-hospital cardiac arrest. To make fair comparisons among health care providers, clinical indicators require case mix adjustment using a validated risk model. The aim of this study was to develop and validate risk models to predict outcomes following in-hospital cardiac arrest attended by a hospital-based resuscitation team in UK hospitals. METHODS: Risk models for two outcomes-return of spontaneous circulation (ROSC) for greater than 20min and survival to hospital discharge-were developed and validated using data for in-hospital cardiac arrests between April 2011 and March 2013...
August 2014: Resuscitation
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