Risk modelling in quality clinical registries : Monitoring lesion treatment failure rate in percutaneous coronary interventions

Smith, Ian R., Cameron, James, Mengersen, Kerrie L., Foster, Kelley A., & Rivers, John T. (2013) Risk modelling in quality clinical registries : Monitoring lesion treatment failure rate in percutaneous coronary interventions. Heart, Lung and Circulation, 22(3), pp. 193-203.

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Aims: This paper describes the development of a risk adjustment (RA) model predictive of individual lesion treatment failure in percutaneous coronary interventions (PCI) for use in a quality monitoring and improvement program.

Methods and results: Prospectively collected data for 3972 consecutive revascularisation procedures (5601 lesions) performed between January 2003 and September 2011 were studied. Data on procedures to September 2009 (n = 3100) were used to identify factors predictive of lesion treatment failure. Factors identified included lesion risk class (p < 0.001), occlusion type (p < 0.001), patient age (p = 0.001), vessel system (p < 0.04), vessel diameter (p < 0.001), unstable angina (p = 0.003) and presence of major cardiac risk factors (p = 0.01). A Bayesian RA model was built using these factors with predictive performance of the model tested on the remaining procedures (area under the receiver operating curve: 0.765, Hosmer–Lemeshow p value: 0.11). Cumulative sum, exponentially weighted moving average and funnel plots were constructed using the RA model and subjectively evaluated.

Conclusion: A RA model was developed and applied to SPC monitoring for lesion failure in a PCI database. If linked to appropriate quality improvement governance response protocols, SPC using this RA tool might improve quality control and risk management by identifying variation in performance based on a comparison of observed and expected outcomes.

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ID Code: 59718
Item Type: Journal Article
Refereed: Yes
Keywords: Angioplasty, Case mix or risk adjustment, Clinical governance, Quality improvement, Statistical process control
DOI: 10.1016/j.hlc.2012.10.001
ISSN: 1444-2892
Divisions: Current > Schools > School of Chemistry, Physics & Mechanical Engineering
Current > QUT Faculties and Divisions > Science & Engineering Faculty
Copyright Owner: © 2012 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier Inc. All rights reserved.
Copyright Statement: This is the author's version of a work that was accepted for publication in Heart, Lung and Circulation. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Heart, Lung and Circulation, [Vol. 22, No. 3, (2013] doi: 10.1016/j.hlc.2012.10.001)
Deposited On: 06 May 2013 22:47
Last Modified: 12 Jun 2013 15:46

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