Improving American College of Surgeons National Surgical Quality Improvement Program Risk Adjustment: Incorporation of a Novel Procedure Risk Score
ABSTRACT Risk-adjusted evaluation is a key component of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP). The purpose of this study was to improve standard ACS NSQIP risk adjustment using a novel procedure risk score.
Current Procedural Terminology codes (CPTs) represented in ACS NSQIP data were assigned to 136 procedure groups. Log odds predicted risk from preliminary logistic regression modeling generated a continuous risk score for each procedure group, used in subsequent modeling. Appropriate subsets of 271,368 patients in the 2008 ACS NSQIP were evaluated using logistic models for overall 30-day morbidity, 30-day mortality, and surgical site infection (SSI). Models were compared when including either work Relative Value Unit (RVU), RVU and the standard ACS NSQIP CPT range variable (CPT range), or RVU and the newly constructed CPT risk score (CPT risk), plus routine ACS NSQIP predictors.
When comparing the CPT risk models with the CPT range models for morbidity in the overall general and vascular surgery dataset, CPT risk models provided better discrimination through higher c statistics at earlier steps (0.81 by step 3 vs 0.81 by step 46), more information through lower Akaike's information criterion (127,139 vs 130,019), and improved calibration through a smaller Hosmer-Lemeshow chi-square statistic (48.76 vs 116.79). Improved model characteristics of CPT risk over CPT range were most apparent for broader patient populations and outcomes. The CPT risk and standard CPT range models were moderately consistent in identification of outliers as well as assignment of hospitals to quality deciles (weighted kappa ≥ 0.870).
Information from focused, clinically meaningful CPT procedure groups improves the risk estimation of ACS NSQIP models.
Conference Paper: Room temperature diamond coatings for field emittersVacuum Microelectronics Conference, 1997. Technical Digest., 1997 10th International; 09/1997
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ABSTRACT: Many of the environmental management issues which plague decision making processes can be poorly-defined scientifically, or misunderstood in real situations. Even as additional scientific studies clarify issues or impacts, (lack of) communication becomes the governing factor when external stakeholders are involved. In public participation processes, alternative dispute resolution techniques are being continually refined to enhance communication among stakeholders. The science of decision support is also evolving to allow direct participation of stakeholders in planning processes. This paper presents a framework for improving the public consultation process for the case of a popular recreational lake in central Alberta that receives discharge from a coal-fired power plant. Focus is given to the application of a fuzzy decision analysis technique to express subjectivities among stakeholders, and uncertainties in data representation. The fuzzy compromise approach is used to express subjective stakeholder evaluations for the purpose of providing feedback concerning the relative uncertainties in the performance for available alternatives, and for examining the implications of risk averse behaviour among stakeholders. The benefits of incorporating fuzzy sets to express subjectivity and model uncertainty is to clarify the relative performance of alternatives within a risk-based approach, and to identify data gaps which may impact the perception of alternatives or may be sensitive to diverse stakeholder perspectivesSystems, Man, and Cybernetics, 1997. Computational Cybernetics and Simulation., 1997 IEEE International Conference on; 11/1997
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ABSTRACT: Pyloromyotomy is a common operative procedure performed on infants. The purpose of this study was to determine if hospital type affects lengths of stay (LOS), charges, and morbidity. Patients undergoing pyloromyotomy were identified in the Kids' Inpatients Database from 2000, 2003, and 2006. Freestanding children's hospitals (CH) were compared with children's units within general hospitals (CUGH) and general/nonchildren's hospitals (GH). Of the 10,969 patients, 25% received care at 30 CH, 35% received care at 94 CUGH, and 40% received care at 662 GH. Adjusted LOS were 2.41 days for CH, 2.75 days for CUGH, and 2.82 days for GH (P < .01). Adjusted mean charges were $11,160 for CH, $12,284 for CUGH, and $10,197 for GH (P = .01). CH had the lowest unadjusted complication rate at 1.2% compared with 1.6% at CUGH and 2.2% at GH (P < .01). GH were more likely to have patients with prolonged LOS (> or =4 days) compared with CH after adjusting for patient and hospital factors (odds ratio [OR], 1.7; 95% confidence interval [CI], 1.2-2.5). After accounting for LOS, CUGH were more likely to have higher charges (> or =$11,057) compared with CH (OR, 3.4; 95% CI, 1.03-11.18). The adjusted mean charges rose from $7,733 in 2000 to $11,335 in 2003 and to $14,572 in 2006 (P < .01). CH had the shortest LOS and lowest complication rates. Despite a higher complication rate and longer LOS, GH had the lowest charges. There is an opportunity to identify best practices, to improve quality, and to lower costs for pyloromyotomy in the United States, regardless of hospital type.Surgery 08/2010; 148(2):411-9. DOI:10.1016/j.surg.2010.04.015 · 3.11 Impact Factor