• J. Am. Coll. Cardiol. · Aug 2013

    Comparative Study

    Risk-standardizing survival for in-hospital cardiac arrest to facilitate hospital comparisons.

    • Paul S Chan, Robert A Berg, John A Spertus, Lee H Schwamm, Deepak L Bhatt, Gregg C Fonarow, Paul A Heidenreich, Brahmajee K Nallamothu, Fengming Tang, Raina M Merchant, and AHA GWTG-Resuscitation Investigators.
    • Saint Luke's Mid America Heart Institute, Kansas City, Missouri; University of Missouri, Kansas City, Missouri 64111, USA. pchan@cc-pc.com
    • J. Am. Coll. Cardiol. 2013 Aug 13;62(7):601-9.

    ObjectivesThe purpose of this study is to develop a method for risk-standardizing hospital survival after cardiac arrest.BackgroundA foundation with which hospitals can improve quality is to be able to benchmark their risk-adjusted performance against other hospitals, something that cannot currently be done for survival after in-hospital cardiac arrest.MethodsWithin the Get With The Guidelines (GWTG)-Resuscitation registry, we identified 48,841 patients admitted between 2007 and 2010 with an in-hospital cardiac arrest. Using hierarchical logistic regression, we derived and validated a model for survival to hospital discharge and calculated risk-standardized survival rates (RSSRs) for 272 hospitals with at least 10 cardiac arrest cases.ResultsThe survival rate was 21.0% and 21.2% for the derivation and validation cohorts, respectively. The model had good discrimination (C-statistic 0.74) and excellent calibration. Eighteen variables were associated with survival to discharge, and a parsimonious model contained 9 variables with minimal change in model discrimination. Before risk adjustment, the median hospital survival rate was 20% (interquartile range: 14% to 26%), with a wide range (0% to 85%). After adjustment, the distribution of RSSRs was substantially narrower: median of 21% (interquartile range: 19% to 23%; range 11% to 35%). More than half (143 [52.6%]) of hospitals had at least a 10% positive or negative absolute change in percentile rank after risk standardization, and 50 (23.2%) had a ≥20% absolute change in percentile rank.ConclusionsWe have derived and validated a model to risk-standardize hospital rates of survival for in-hospital cardiac arrest. Use of this model can support efforts to compare hospitals in resuscitation outcomes as a foundation for quality assessment and improvement.Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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