Catheterization for Congenital Heart Disease Adjustment for Risk Method II
BACKGROUND: Current metrics used to adjust for case mix complexity in congenital cardiac catheterization are becoming outdated due to the introduction of novel procedures, innovative technologies, and expanding patient subgroups. This study aims to develop a risk adjustment methodology introducing a novel, clinically meaningful adverse event outcome and incorporating a modern understanding of risk.
METHODS: Data from diagnostic only and interventional cases with defined case types were collected for patients ≤18 years of age and ≥2.5 kg at all Congenital Cardiac Catheterization Project on Outcomes participating centers. The derivation data set consisted of cases performed from 2014 to 2017, and the validation data set consisted of cases performed from 2019 to 2020. Severity level 3 adverse events were stratified into 3 tiers by clinical impact (3a/b/c); the study outcome was clinically meaningful adverse events, severity level ≥3b (3bc/4/5).
RESULTS: The derivation data set contained 15 224 cases, and the validation data set included 9462 cases. Clinically meaningful adverse event rates were 4.5% and 4.2% in the derivation and validation cohorts, respectively. The final risk adjustment model included age <30 days, Procedural Risk in Congenital Cardiac Catheterization risk category, and hemodynamic vulnerability score (C statistic, 0.70; Hosmer-Lemeshow P value, 0.83; Brier score, 0.042).
CONCLUSIONS: CHARM II (Congenital Heart Disease Adjustment for Risk Method II) risk adjustment methodology allows for equitable comparison of clinically meaningful adverse events among institutions and operators with varying patient populations and case mix complexity performing pediatric cardiac catheterization.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:17 |
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| Enthalten in: |
Circulation. Cardiovascular interventions - 17(2024), 3 vom: 23. März, Seite e012834 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Quinn, Brian P [VerfasserIn] |
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| Links: |
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| Themen: |
Heart defects, congenital |
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| Anmerkungen: |
Date Completed 21.03.2024 Date Revised 29.03.2024 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1161/CIRCINTERVENTIONS.123.012834 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM367490471 |
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| 500 | |a Citation Status MEDLINE | ||
| 520 | |a BACKGROUND: Current metrics used to adjust for case mix complexity in congenital cardiac catheterization are becoming outdated due to the introduction of novel procedures, innovative technologies, and expanding patient subgroups. This study aims to develop a risk adjustment methodology introducing a novel, clinically meaningful adverse event outcome and incorporating a modern understanding of risk | ||
| 520 | |a METHODS: Data from diagnostic only and interventional cases with defined case types were collected for patients ≤18 years of age and ≥2.5 kg at all Congenital Cardiac Catheterization Project on Outcomes participating centers. The derivation data set consisted of cases performed from 2014 to 2017, and the validation data set consisted of cases performed from 2019 to 2020. Severity level 3 adverse events were stratified into 3 tiers by clinical impact (3a/b/c); the study outcome was clinically meaningful adverse events, severity level ≥3b (3bc/4/5) | ||
| 520 | |a RESULTS: The derivation data set contained 15 224 cases, and the validation data set included 9462 cases. Clinically meaningful adverse event rates were 4.5% and 4.2% in the derivation and validation cohorts, respectively. The final risk adjustment model included age <30 days, Procedural Risk in Congenital Cardiac Catheterization risk category, and hemodynamic vulnerability score (C statistic, 0.70; Hosmer-Lemeshow P value, 0.83; Brier score, 0.042) | ||
| 520 | |a CONCLUSIONS: CHARM II (Congenital Heart Disease Adjustment for Risk Method II) risk adjustment methodology allows for equitable comparison of clinically meaningful adverse events among institutions and operators with varying patient populations and case mix complexity performing pediatric cardiac catheterization | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a heart defects, congenital | |
| 650 | 4 | |a hemodynamics | |
| 650 | 4 | |a patient outcome assessment | |
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| 650 | 4 | |a risk adjustment | |
| 700 | 1 | |a Gunnelson, Lauren C |e verfasserin |4 aut | |
| 700 | 1 | |a Kotin, Sarah G |e verfasserin |4 aut | |
| 700 | 1 | |a Gauvreau, Kimberlee |e verfasserin |4 aut | |
| 700 | 1 | |a Yeh, Mary J |e verfasserin |4 aut | |
| 700 | 1 | |a Hasan, Babar |e verfasserin |4 aut | |
| 700 | 1 | |a Lozier, John |e verfasserin |4 aut | |
| 700 | 1 | |a Barry, Oliver M |e verfasserin |4 aut | |
| 700 | 1 | |a Shahanavaz, Shabana |e verfasserin |4 aut | |
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