Catheterization for Congenital Heart Disease Adjustment for Risk Method (CHARM)

Area of Science:

• Pediatric Cardiology
• Health Services Research
• Medical Informatics

Background:

• The Congenital Cardiac Catheterization Project on Outcomes (C3PO) has collected data on pediatric cardiac catheterization cases since 2007.
• Data is gathered prospectively from 8 pediatric institutions using a web-based tool.

Purpose of the Study:

• To develop a risk adjustment method for case mix complexity in congenital heart disease (CHD) catheterization.
• To enable equitable comparison of adverse event (AE) rates across institutions.

Main Methods:

• A multivariable logistic regression model was created using 75% of the C3PO cohort data.
• The model predicted high-severity AEs and was validated on the remaining 25% of cases.
• Standardized AE ratios were calculated using the final models.

Main Results:

• The study analyzed 9,362 cases from August 2007 to December 2009, with a 5% high-severity AE rate.
• Four independent indicators of hemodynamic vulnerability were identified: procedure risk category, number of hemodynamic indicators, and age <1 year.
• The final model demonstrated good discrimination (C-statistic 0.737) and calibration (Hosmer-Lemeshow p = 0.74).

Conclusions:

• The developed method, CHARM (Catheterization for Congenital Heart Disease Adjustment for Risk Method), effectively adjusts for case mix complexity.
• CHARM facilitates standardized comparisons of AE rates for CHD catheterization among different institutions.