Case Study 4
Risk Adjustment with Multivariate Techniques (New York)
The state of New York (http://www.health.state.ny.us/nysdoh/consumer/heart/1996-98cabg.pdf) has reported risk adjusted mortality statistics for coronary artery bypass graft surgery (CABG) for a number of years, as discussed earlier in the text. New York uses the second major approach to risk adjustment, a multivariate model. Such models control for different kinds of patient characteristics that are likely to influence mortality. Table 4.1 reports the multivariate model used to calculate this risk-adjusted measure. (Textbook Case Study 6.4)
Table 4.1: Multivariable risk factor equation for CABG hospital deaths in New York State in 1998.
Patient Risk Factor
Malignant Ventricular Arrhythmia
Renal Failure (no dialysis), Creatinine > 2.5
Renal Failure requiring Dialysis
Severity of Atherosclerotic Process
Ejection Fraction <20
Ejection Fraction 20-29
Ejection Fraction 30-39
Previous Open Heart Operations
Intercept = -9.4988
C Statistic = 0.793
Case Questions: Answer the case questions, with research from your book, CDC, NIH and other quality sources to determine answers and solutions. You are to write a 2-3 page paper in APA formatting that addresses the following questions. Note: A minimum of two references should be used, which should include your textbook and the CDC, and others that support your responses in your paper. This is a paper, so your answer should not be numbered, but rather it should use titles and subtitles.
1. Which factors are supposedly related to CABG morality?
2. Which factors are the most strongly related to CABG mortality?
3. How could one derive an expected mortality rate from the multivariate model?
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