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  • Title: Present-at-admission diagnoses improved mortality risk adjustment among acute myocardial infarction patients.
    Author: Stukenborg GJ, Wagner DP, Harrell FE, Oliver MN, Heim SW, Price AL, Han CK, Wolf AM, Connors AF.
    Journal: J Clin Epidemiol; 2007 Feb; 60(2):142-54. PubMed ID: 17208120.
    Abstract:
    OBJECTIVE: Hospital mortality outcomes for acute myocardial infarction (AMI) patients are a focus of quality improvement programs conducted by government agencies. AMI mortality risk-adjustment models using administrative data typically adjust for baseline differences in mortality risk with a limited set of common and definite comorbidities. In this study, we present an AMI mortality risk-adjustment model that adjusts for comorbid disease and for AMI severity using information from secondary diagnoses reported as present at admission for California hospital patients. STUDY DESIGN AND SETTING: AMI patients were selected from California hospital administrative data for 1996 through 1999 according to criteria used by the California Hospital Outcomes Project Report on Heart Attack Outcomes, a state-mandated public report that compares hospital mortality outcomes. We compared results for the new model to two mortality risk-adjustment models used to assess hospital AMI mortality outcomes by the state of California, and to two other models used in prior research. RESULTS: The model using present-at-admission diagnoses obtained substantially better discrimination between predicted survival and inpatient death than the other models we considered. CONCLUSION: AMI mortality risk-adjustment methods can be meaningfully improved using present-at-admission diagnoses to identify comorbid disease and conditions related closely to AMI.
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