14 Jun Question HCM530 Case Study 4 Risk Adjustment with Mult
Question
HCM530
Case Study 4
Risk Adjustment with Multivariate Techniques (New York)
The state of New York (http://www.health.state.ny.us/nysdoh/consumer/heart/1996-98cabg.pdf) has
reported risk adjusted mortality statistics for coronary artery bypass graft surgery (CABG) for a number
of years, as discussed earlier in the text. New York uses the second major approach to risk adjustment, a
multivariate model. Such models control for different kinds of patient characteristics that are likely to
influence mortality. Table 4.1 reports the multivariate model used to calculate this risk-adjusted
measure. (Textbook Case Study 6.4)
Table 4.1: Multivariable risk factor equation for CABG hospital deaths in New York State in 1998.
Logistic Regression
Patient Risk Factor Prevalence (%) Coefficient P-Value Odds Ratio
Demographics
Age …. 0.0671 <0.0001 1.069 Female Gender 28.92 0.5105 <0.0001 1.666 Hemodynamic State Unstable 1.32 1.0423 <0.0001 2.836 Shock 0.45 1.8458 <0.0001 6.333 Comorbidities Diabetes 30.91 0.3607 0.0010 1.434 Malignant Ventricular Arrhythmia 2.228 0.9759 <0.0001 2.654 COPD 15.97 0.5012 <0.0001 1.651 Renal Failure (no dialysis), Creatinine > 2.5 1.89 0.9213 <0.0001 2.513 Renal Failure requiring Dialysis 1.89 0.9213 <0.0001 5.688 Hepatic Failure 0.10 3.0535 <0.0001 21.190 Severity of Atherosclerotic Process Aortoiliac Disease 5.42 0.5481 0.0006 1.730 Stroke 7.01 0.4775 0.0016 1.621 Ventricular Function Ejection Fraction <20 1.77 1.4235 <0.0001 4.151 Ejection Fraction 20-29 7.40 0.8183 <0.0001 2.267 Ejection Fraction 30-39 14.49 0.6186 <0.0001 1.856 Previous Open Heart Operations 5.98 0.6800 <0.0001 1.974 Intercept = -9.4988 C Statistic = 0.793 Case Questions: Answer the case questions, with research from your book, CDC, NIH and other quality sources to determine answers and solutions. You are to write a 2-3 page paper in APA formatting that addresses the following questions. Note: A minimum of two references should be used, which should include your textbook and the CDC, and others that support your responses in your paper. This is a mpaper, so your answer should not be numbered, but rather it should use titles and subtitles. 1. Which factors are supposedly related to CABG morality? 2. Which factors are the most strongly related to CABG mortality? 3. How could one derive an expected mortality rate from the multivariate model?
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