Comparison between an empirically derived model and the EuroSCORE system in the evaluation of hospital performance: the example of the Italian CABG Outcome Project
Objectives: To compare the risk-adjustment model empirically derived from the ‘Italian CABG Outcome Project’ with that of the additive and logistic EuroSCORE in terms of accuracy, predictive power and ability to rank hospital performances. Methods: The Italian CABG model, the logistic and additive E...
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| Veröffentlicht in: | European journal of cardio-thoracic surgery 2008-03, Vol.33 (3), p.325-333 |
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| creator | D’Errigo, Paola Seccareccia, Fulvia Rosato, Stefano Manno, Valerio Badoni, Gabriella Fusco, Danilo Perucci, Carlo A. |
| description | Objectives: To compare the risk-adjustment model empirically derived from the ‘Italian CABG Outcome Project’ with that of the additive and logistic EuroSCORE in terms of accuracy, predictive power and ability to rank hospital performances. Methods: The Italian CABG model, the logistic and additive EuroSCORE were applied to the Italian CABG population; the observed deaths/expected deaths (O/E) ratios, as obtained by the three models, were computed for each Italian cardiac surgery centre and for six classes of risk-stratified patients. The performance of the three models in predicting the 30-day mortality was formally assessed for calibration (Hosmer–Lemeshow test) and discrimination (ROC area). According to the three models, risk-adjusted mortality rates (RAMR = O/E × Italian CABG population mortality rate) were estimated for each centre; possible differences were detected in the identification of hospitals with mortality rates higher and lower than average. Results: The Italian CABG model uses fewer variables than the EuroSCORE system (14 vs 17) and exhibits the best performance in terms of discrimination and calibration. Contrary to the other tested models, the logistic EuroSCORE shows a significant Hosmer–Lemeshow test ( , p |
| doi_str_mv | 10.1016/j.ejcts.2007.12.001 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_70306377</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><oup_id>10.1016/j.ejcts.2007.12.001</oup_id><sourcerecordid>70306377</sourcerecordid><originalsourceid>FETCH-LOGICAL-c445t-2c60d489373e580da19f544e7fc65c3257cd75f9bb98ff37745bacd15e7c06c83</originalsourceid><addsrcrecordid>eNqNkc1u1DAUhSMEoqXwBEjIG9gl2HESJ-zaaGgrjTTQAVR1YznOteohiYPttJ3n6YviNKOyZeW_75xrnRNF7wlOCCbF510CO-ldkmLMEpImGJMX0TEpGY0Zza5fhj0mOGZVho-iN87tMMYFTdnr6IiUKSZlRY6jx9r0o7DamQE14O8BBiQGBP2orZai6_aoBavvoEW9aaELjy3yt4BWkzXbenO1Qm7vPPRID0_3cCe6SXgd_IxCt8aN2osOjWCVsb0YJHxZuAfRjx3M0Hy8DJAOg-vTs3O0mbw0PaBv1uxA-rfRKyU6B-8O60n08-vqR30Rrzfnl_XpOpZZlvs4lQVus7KijEJe4laQSuVZBkzJIpc0zZlsWa6qpqlKpShjWd4I2ZIcmMSFLOlJ9GnxHa35M4HzvNdOQteJAczkOMM0BMhYAOkCSmucs6D4aHUv7J4TzOdu-I4_dcPnbjhJeegmqD4c7Kemh_af5lBGAD4eAOFC9MqGtLR75gKV5biY_5ksnJnG_5wcLwIdmnp4lgj7mxeMspxfXN_wm-_kCm9_bfma_gV6Nbmf</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>70306377</pqid></control><display><type>article</type><title>Comparison between an empirically derived model and the EuroSCORE system in the evaluation of hospital performance: the example of the Italian CABG Outcome Project</title><source>MEDLINE</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>Oxford University Press Journals All Titles (1996-Current)</source><creator>D’Errigo, Paola ; Seccareccia, Fulvia ; Rosato, Stefano ; Manno, Valerio ; Badoni, Gabriella ; Fusco, Danilo ; Perucci, Carlo A.</creator><creatorcontrib>D’Errigo, Paola ; Seccareccia, Fulvia ; Rosato, Stefano ; Manno, Valerio ; Badoni, Gabriella ; Fusco, Danilo ; Perucci, Carlo A. ; Research Group of the Italian CABG Outcome Project</creatorcontrib><description>Objectives: To compare the risk-adjustment model empirically derived from the ‘Italian CABG Outcome Project’ with that of the additive and logistic EuroSCORE in terms of accuracy, predictive power and ability to rank hospital performances. Methods: The Italian CABG model, the logistic and additive EuroSCORE were applied to the Italian CABG population; the observed deaths/expected deaths (O/E) ratios, as obtained by the three models, were computed for each Italian cardiac surgery centre and for six classes of risk-stratified patients. The performance of the three models in predicting the 30-day mortality was formally assessed for calibration (Hosmer–Lemeshow test) and discrimination (ROC area). According to the three models, risk-adjusted mortality rates (RAMR = O/E × Italian CABG population mortality rate) were estimated for each centre; possible differences were detected in the identification of hospitals with mortality rates higher and lower than average. Results: The Italian CABG model uses fewer variables than the EuroSCORE system (14 vs 17) and exhibits the best performance in terms of discrimination and calibration. Contrary to the other tested models, the logistic EuroSCORE shows a significant Hosmer–Lemeshow test ( , p < 0.0001), indicating unsatisfactory calibration, and a clear predicted death overestimation in each of the considered risk classes (O/E = 0.4). When a proper recalibration procedure is applied, the logistic EuroSCORE performance parameters achieve acceptable levels. The Italian CABG model identified seven centres as having higher than average mortality, while the EuroSCORE identified the same seven centres plus one other. The Italian CABG model identified eight centres with lower than average mortality, five of which were identified by the additive EuroSCORE and four of which were identified by the logistic EuroSCORE. The additive EuroSCORE identified four more and the logistic EuroSCORE three more low mortality centres. Conclusions: Although this analysis reveals a satisfactory concordance between results from the three models, a detailed comparison shows that the Italian CABG model uses fewer variables and performs better than the others. Nevertheless, when properly recalibrated, the EuroSCORE model can be exported to the Italian population and used to rank hospital performance and evaluate preoperative risk of patients undergoing open-heart surgery.</description><identifier>ISSN: 1010-7940</identifier><identifier>EISSN: 1873-734X</identifier><identifier>DOI: 10.1016/j.ejcts.2007.12.001</identifier><identifier>PMID: 18201891</identifier><identifier>CODEN: EJCSE7</identifier><language>eng</language><publisher>Amsterdam: Elsevier Science B.V</publisher><subject>Adult ; Aged ; Biological and medical sciences ; Cardiology. Vascular system ; Coronary Artery Bypass - mortality ; Coronary artery bypass graft ; Coronary heart disease ; EuroSCORE ; Female ; Heart ; Hospital Mortality ; Hospitals, Public - standards ; Humans ; Italy - epidemiology ; Male ; Medical sciences ; Middle Aged ; Models, Statistical ; Outcome Assessment (Health Care) - methods ; Pneumology ; Risk Assessment - methods ; Risk-adjustment ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the heart</subject><ispartof>European journal of cardio-thoracic surgery, 2008-03, Vol.33 (3), p.325-333</ispartof><rights>European Association for Cardio-Thoracic Surgery © 2007 European Association for Cardio-Thoracic Surgery 2007</rights><rights>2008 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c445t-2c60d489373e580da19f544e7fc65c3257cd75f9bb98ff37745bacd15e7c06c83</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=20145068$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18201891$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>D’Errigo, Paola</creatorcontrib><creatorcontrib>Seccareccia, Fulvia</creatorcontrib><creatorcontrib>Rosato, Stefano</creatorcontrib><creatorcontrib>Manno, Valerio</creatorcontrib><creatorcontrib>Badoni, Gabriella</creatorcontrib><creatorcontrib>Fusco, Danilo</creatorcontrib><creatorcontrib>Perucci, Carlo A.</creatorcontrib><creatorcontrib>Research Group of the Italian CABG Outcome Project</creatorcontrib><title>Comparison between an empirically derived model and the EuroSCORE system in the evaluation of hospital performance: the example of the Italian CABG Outcome Project</title><title>European journal of cardio-thoracic surgery</title><addtitle>Eur J Cardiothorac Surg</addtitle><addtitle>Eur J Cardiothorac Surg</addtitle><description>Objectives: To compare the risk-adjustment model empirically derived from the ‘Italian CABG Outcome Project’ with that of the additive and logistic EuroSCORE in terms of accuracy, predictive power and ability to rank hospital performances. Methods: The Italian CABG model, the logistic and additive EuroSCORE were applied to the Italian CABG population; the observed deaths/expected deaths (O/E) ratios, as obtained by the three models, were computed for each Italian cardiac surgery centre and for six classes of risk-stratified patients. The performance of the three models in predicting the 30-day mortality was formally assessed for calibration (Hosmer–Lemeshow test) and discrimination (ROC area). According to the three models, risk-adjusted mortality rates (RAMR = O/E × Italian CABG population mortality rate) were estimated for each centre; possible differences were detected in the identification of hospitals with mortality rates higher and lower than average. Results: The Italian CABG model uses fewer variables than the EuroSCORE system (14 vs 17) and exhibits the best performance in terms of discrimination and calibration. Contrary to the other tested models, the logistic EuroSCORE shows a significant Hosmer–Lemeshow test ( , p < 0.0001), indicating unsatisfactory calibration, and a clear predicted death overestimation in each of the considered risk classes (O/E = 0.4). When a proper recalibration procedure is applied, the logistic EuroSCORE performance parameters achieve acceptable levels. The Italian CABG model identified seven centres as having higher than average mortality, while the EuroSCORE identified the same seven centres plus one other. The Italian CABG model identified eight centres with lower than average mortality, five of which were identified by the additive EuroSCORE and four of which were identified by the logistic EuroSCORE. The additive EuroSCORE identified four more and the logistic EuroSCORE three more low mortality centres. Conclusions: Although this analysis reveals a satisfactory concordance between results from the three models, a detailed comparison shows that the Italian CABG model uses fewer variables and performs better than the others. Nevertheless, when properly recalibrated, the EuroSCORE model can be exported to the Italian population and used to rank hospital performance and evaluate preoperative risk of patients undergoing open-heart surgery.</description><subject>Adult</subject><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Cardiology. Vascular system</subject><subject>Coronary Artery Bypass - mortality</subject><subject>Coronary artery bypass graft</subject><subject>Coronary heart disease</subject><subject>EuroSCORE</subject><subject>Female</subject><subject>Heart</subject><subject>Hospital Mortality</subject><subject>Hospitals, Public - standards</subject><subject>Humans</subject><subject>Italy - epidemiology</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Models, Statistical</subject><subject>Outcome Assessment (Health Care) - methods</subject><subject>Pneumology</subject><subject>Risk Assessment - methods</subject><subject>Risk-adjustment</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Surgery of the heart</subject><issn>1010-7940</issn><issn>1873-734X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkc1u1DAUhSMEoqXwBEjIG9gl2HESJ-zaaGgrjTTQAVR1YznOteohiYPttJ3n6YviNKOyZeW_75xrnRNF7wlOCCbF510CO-ldkmLMEpImGJMX0TEpGY0Zza5fhj0mOGZVho-iN87tMMYFTdnr6IiUKSZlRY6jx9r0o7DamQE14O8BBiQGBP2orZai6_aoBavvoEW9aaELjy3yt4BWkzXbenO1Qm7vPPRID0_3cCe6SXgd_IxCt8aN2osOjWCVsb0YJHxZuAfRjx3M0Hy8DJAOg-vTs3O0mbw0PaBv1uxA-rfRKyU6B-8O60n08-vqR30Rrzfnl_XpOpZZlvs4lQVus7KijEJe4laQSuVZBkzJIpc0zZlsWa6qpqlKpShjWd4I2ZIcmMSFLOlJ9GnxHa35M4HzvNdOQteJAczkOMM0BMhYAOkCSmucs6D4aHUv7J4TzOdu-I4_dcPnbjhJeegmqD4c7Kemh_af5lBGAD4eAOFC9MqGtLR75gKV5biY_5ksnJnG_5wcLwIdmnp4lgj7mxeMspxfXN_wm-_kCm9_bfma_gV6Nbmf</recordid><startdate>20080301</startdate><enddate>20080301</enddate><creator>D’Errigo, Paola</creator><creator>Seccareccia, Fulvia</creator><creator>Rosato, Stefano</creator><creator>Manno, Valerio</creator><creator>Badoni, Gabriella</creator><creator>Fusco, Danilo</creator><creator>Perucci, Carlo A.</creator><general>Elsevier Science B.V</general><general>Elsevier Science</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20080301</creationdate><title>Comparison between an empirically derived model and the EuroSCORE system in the evaluation of hospital performance: the example of the Italian CABG Outcome Project</title><author>D’Errigo, Paola ; Seccareccia, Fulvia ; Rosato, Stefano ; Manno, Valerio ; Badoni, Gabriella ; Fusco, Danilo ; Perucci, Carlo A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c445t-2c60d489373e580da19f544e7fc65c3257cd75f9bb98ff37745bacd15e7c06c83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Cardiology. Vascular system</topic><topic>Coronary Artery Bypass - mortality</topic><topic>Coronary artery bypass graft</topic><topic>Coronary heart disease</topic><topic>EuroSCORE</topic><topic>Female</topic><topic>Heart</topic><topic>Hospital Mortality</topic><topic>Hospitals, Public - standards</topic><topic>Humans</topic><topic>Italy - epidemiology</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Models, Statistical</topic><topic>Outcome Assessment (Health Care) - methods</topic><topic>Pneumology</topic><topic>Risk Assessment - methods</topic><topic>Risk-adjustment</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surgery of the heart</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>D’Errigo, Paola</creatorcontrib><creatorcontrib>Seccareccia, Fulvia</creatorcontrib><creatorcontrib>Rosato, Stefano</creatorcontrib><creatorcontrib>Manno, Valerio</creatorcontrib><creatorcontrib>Badoni, Gabriella</creatorcontrib><creatorcontrib>Fusco, Danilo</creatorcontrib><creatorcontrib>Perucci, Carlo A.</creatorcontrib><creatorcontrib>Research Group of the Italian CABG Outcome Project</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of cardio-thoracic surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>D’Errigo, Paola</au><au>Seccareccia, Fulvia</au><au>Rosato, Stefano</au><au>Manno, Valerio</au><au>Badoni, Gabriella</au><au>Fusco, Danilo</au><au>Perucci, Carlo A.</au><aucorp>Research Group of the Italian CABG Outcome Project</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Comparison between an empirically derived model and the EuroSCORE system in the evaluation of hospital performance: the example of the Italian CABG Outcome Project</atitle><jtitle>European journal of cardio-thoracic surgery</jtitle><stitle>Eur J Cardiothorac Surg</stitle><addtitle>Eur J Cardiothorac Surg</addtitle><date>2008-03-01</date><risdate>2008</risdate><volume>33</volume><issue>3</issue><spage>325</spage><epage>333</epage><pages>325-333</pages><issn>1010-7940</issn><eissn>1873-734X</eissn><coden>EJCSE7</coden><abstract>Objectives: To compare the risk-adjustment model empirically derived from the ‘Italian CABG Outcome Project’ with that of the additive and logistic EuroSCORE in terms of accuracy, predictive power and ability to rank hospital performances. Methods: The Italian CABG model, the logistic and additive EuroSCORE were applied to the Italian CABG population; the observed deaths/expected deaths (O/E) ratios, as obtained by the three models, were computed for each Italian cardiac surgery centre and for six classes of risk-stratified patients. The performance of the three models in predicting the 30-day mortality was formally assessed for calibration (Hosmer–Lemeshow test) and discrimination (ROC area). According to the three models, risk-adjusted mortality rates (RAMR = O/E × Italian CABG population mortality rate) were estimated for each centre; possible differences were detected in the identification of hospitals with mortality rates higher and lower than average. Results: The Italian CABG model uses fewer variables than the EuroSCORE system (14 vs 17) and exhibits the best performance in terms of discrimination and calibration. Contrary to the other tested models, the logistic EuroSCORE shows a significant Hosmer–Lemeshow test ( , p < 0.0001), indicating unsatisfactory calibration, and a clear predicted death overestimation in each of the considered risk classes (O/E = 0.4). When a proper recalibration procedure is applied, the logistic EuroSCORE performance parameters achieve acceptable levels. The Italian CABG model identified seven centres as having higher than average mortality, while the EuroSCORE identified the same seven centres plus one other. The Italian CABG model identified eight centres with lower than average mortality, five of which were identified by the additive EuroSCORE and four of which were identified by the logistic EuroSCORE. The additive EuroSCORE identified four more and the logistic EuroSCORE three more low mortality centres. Conclusions: Although this analysis reveals a satisfactory concordance between results from the three models, a detailed comparison shows that the Italian CABG model uses fewer variables and performs better than the others. Nevertheless, when properly recalibrated, the EuroSCORE model can be exported to the Italian population and used to rank hospital performance and evaluate preoperative risk of patients undergoing open-heart surgery.</abstract><cop>Amsterdam</cop><pub>Elsevier Science B.V</pub><pmid>18201891</pmid><doi>10.1016/j.ejcts.2007.12.001</doi><tpages>9</tpages></addata></record> |
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| subjects | Adult Aged Biological and medical sciences Cardiology. Vascular system Coronary Artery Bypass - mortality Coronary artery bypass graft Coronary heart disease EuroSCORE Female Heart Hospital Mortality Hospitals, Public - standards Humans Italy - epidemiology Male Medical sciences Middle Aged Models, Statistical Outcome Assessment (Health Care) - methods Pneumology Risk Assessment - methods Risk-adjustment Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the heart |
| title | Comparison between an empirically derived model and the EuroSCORE system in the evaluation of hospital performance: the example of the Italian CABG Outcome Project |
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