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Original Article

Derivation and Validation of a Risk Standardization Model for Benchmarking Hospital Performance for Health-Related Quality of Life Outcomes After Acute Myocardial InfarctionCLINICAL PERSPECTIVE

Suzanne V. Arnold, Frederick A. Masoudi, John S. Rumsfeld, Yan Li, Philip G. Jones, John A. Spertus
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https://doi.org/10.1161/CIRCULATIONAHA.113.001773
Circulation. 2014;129:313-320
Originally published January 20, 2014
Suzanne V. Arnold
From Saint Luke’s Mid America Heart Institute, Kansas City, MO (S.V.A., Y.L., P.G.J., J.A.S.); University of Missouri-Kansas City, Kansas City, MO (S.V.A., J.A.S.); and the Division of Cardiology, University of Colorado, Denver, CO (F.A.M., J.S.R.).
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Frederick A. Masoudi
From Saint Luke’s Mid America Heart Institute, Kansas City, MO (S.V.A., Y.L., P.G.J., J.A.S.); University of Missouri-Kansas City, Kansas City, MO (S.V.A., J.A.S.); and the Division of Cardiology, University of Colorado, Denver, CO (F.A.M., J.S.R.).
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John S. Rumsfeld
From Saint Luke’s Mid America Heart Institute, Kansas City, MO (S.V.A., Y.L., P.G.J., J.A.S.); University of Missouri-Kansas City, Kansas City, MO (S.V.A., J.A.S.); and the Division of Cardiology, University of Colorado, Denver, CO (F.A.M., J.S.R.).
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Yan Li
From Saint Luke’s Mid America Heart Institute, Kansas City, MO (S.V.A., Y.L., P.G.J., J.A.S.); University of Missouri-Kansas City, Kansas City, MO (S.V.A., J.A.S.); and the Division of Cardiology, University of Colorado, Denver, CO (F.A.M., J.S.R.).
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Philip G. Jones
From Saint Luke’s Mid America Heart Institute, Kansas City, MO (S.V.A., Y.L., P.G.J., J.A.S.); University of Missouri-Kansas City, Kansas City, MO (S.V.A., J.A.S.); and the Division of Cardiology, University of Colorado, Denver, CO (F.A.M., J.S.R.).
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John A. Spertus
From Saint Luke’s Mid America Heart Institute, Kansas City, MO (S.V.A., Y.L., P.G.J., J.A.S.); University of Missouri-Kansas City, Kansas City, MO (S.V.A., J.A.S.); and the Division of Cardiology, University of Colorado, Denver, CO (F.A.M., J.S.R.).
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Abstract

Background—Before outcomes-based measures of quality can be used to compare and improve care, they must be risk-standardized to account for variations in patient characteristics. Despite the importance of health-related quality of life (HRQL) outcomes among patients with acute myocardial infarction (AMI), no risk-standardized models have been developed.

Methods and Results—We assessed disease-specific HRQL using the Seattle Angina Questionnaire at baseline and 1 year later in 2693 unselected AMI patients from 24 hospitals enrolled in the Translational Research Investigating Underlying disparities in acute Myocardial infarction Patients’ Health status (TRIUMPH) registry. Using 57 candidate sociodemographic, economic, and clinical variables present on admission, we developed a parsimonious, hierarchical linear regression model to predict HRQL. Eleven variables were independently associated with poor HRQL after AMI, including younger age, previous coronary artery bypass graft surgery, depressive symptoms, and financial difficulties (R2=20%). The model demonstrated excellent internal calibration and reasonable calibration in an independent sample of 1890 AMI patients in a separate registry, although the model slightly overpredicted HRQL scores in the higher deciles. Among the 24 TRIUMPH hospitals, 1-year unadjusted HRQL scores ranged from 67–89. After risk-standardization, HRQL score variability narrowed substantially (range=79–83), and the group of hospital performance (bottom 20%/middle 60%/top 20%) changed in 14 of the 24 hospitals (58% reclassification with risk-standardization).

Conclusions—In this predictive model for HRQL after AMI, we identified risk factors, including economic and psychological characteristics, associated with HRQL outcomes. Adjusting for these factors substantially altered the rankings of hospitals as compared with unadjusted comparisons. Using this model to compare risk-standardized HRQL outcomes across hospitals may identify processes of care that maximize this important patient-centered outcome.

  • myocardial infarction
  • quality of life
  • risk factors
  • Received February 1, 2013.
  • Accepted September 24, 2013.
  • © 2013 American Heart Association, Inc.

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January 21, 2014, Volume 129, Issue 3
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    Derivation and Validation of a Risk Standardization Model for Benchmarking Hospital Performance for Health-Related Quality of Life Outcomes After Acute Myocardial InfarctionCLINICAL PERSPECTIVE
    Suzanne V. Arnold, Frederick A. Masoudi, John S. Rumsfeld, Yan Li, Philip G. Jones and John A. Spertus
    Circulation. 2014;129:313-320, originally published January 20, 2014
    https://doi.org/10.1161/CIRCULATIONAHA.113.001773

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    Derivation and Validation of a Risk Standardization Model for Benchmarking Hospital Performance for Health-Related Quality of Life Outcomes After Acute Myocardial InfarctionCLINICAL PERSPECTIVE
    Suzanne V. Arnold, Frederick A. Masoudi, John S. Rumsfeld, Yan Li, Philip G. Jones and John A. Spertus
    Circulation. 2014;129:313-320, originally published January 20, 2014
    https://doi.org/10.1161/CIRCULATIONAHA.113.001773
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