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Evaluating alternative risk-adjustment strategies for surgery
Adam Atherly1, Aaron S Fink, Darrell C Campbell
1Department of Health Policy and Management, Rollins School of Public Health, Emory University, 1518 Clifton Rd. N.E., Atlanta, GA 30322, USA. aather1@sph.emory.edu
Background:
Comparison of institutional health care outcomes requires risk adjustment. Risk-adjustment methodology may influence the results of such comparisons.
Methods:
We compared 3 risk-adjustment methodologies used to assess the quality of surgical care. Nurse reviewers abstracted data from a continuous sample of 2,167 surgical patients at 3 academic institutions. One risk adjustor was based on medical record data (National Surgical Quality Improvement Program [NSQIP]) whereas the other 2, the DxCG and Charlson Comorbidity Index (CCI), primarily used International Classification of Disease-9 (ICD-9) codes. Risk-assessment scores from the 3 systems were compared with each other and with mortality.
Results:
Substantial disagreement was found in the risk assessment calculated by the 3 methodologies. Although there was a weak association between the CCI and DxCG, neither correlated well with the NSQIP. The NSQIP was best able to predict mortality, followed by the DxCG and CCI.
Conclusion:
In surgical patients, different risk-adjustment methodologies afford divergent estimates of mortality risk.
