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Continuous Monitoring of Risk-Adjusted Outcomes: Excess Deaths vs Lives Saved.

Ruyun Jin1, Gary L Grunkemeier1, Anthony P Furnary2

  • 1Center for Cardiovascular Analytics, Research and Data Science (CARDS), Providence Heart Institute, Providence St. Joseph Health, Portland, Oregon.

The Annals of Thoracic Surgery
|April 27, 2021
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Summary
This summary is machine-generated.

Risk-adjusted surgical outcomes are tracked using graphical methods like Risk-Adjusted CUSUM (RA-CUSUM) and Variable Life Adjusted Display (VLAD). These methods offer continuous monitoring of provider performance over time.

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Area of Science:

  • Medical Informatics
  • Surgical Outcomes Research
  • Health Services Research

Background:

  • Risk-adjusted surgical outcomes reporting is crucial for comparing healthcare providers and monitoring performance trends.
  • Graphical methods, such as the observed-to-expected (O/E) ratio, are commonly employed.
  • Cumulative sum (CUSUM) techniques offer enhanced visualization of performance over time.

Purpose of the Study:

  • To evaluate the utility of Risk-Adjusted CUSUM (RA-CUSUM) and Variable Life Adjusted Display (VLAD) for graphical reporting of risk-adjusted surgical outcomes.
  • To compare these methods with the traditional O/E ratio for performance monitoring.

Main Methods:

  • Utilized operative mortality data from 7255 isolated coronary artery bypass graft (CABG) patients.
  • Data spanned from January 2014 to June 2017.
  • Applied RA-CUSUM and VLAD graphical techniques to analyze the risk-adjusted outcomes.

Main Results:

  • RA-CUSUM and VLAD effectively display risk-adjusted surgical outcomes.
  • These methods provide continuous monitoring capabilities, unlike the static O/E ratio.
  • Demonstrated the application using real-world CABG mortality data.

Conclusions:

  • RA-CUSUM and VLAD are superior graphical methods for displaying and continuously monitoring risk-adjusted surgical outcomes.
  • These techniques offer valuable insights into provider performance variations over time.
  • The study highlights the advantages of CUSUM-based methods in surgical quality assessment.