PMID- 33837102 OWN - NLM STAT- MEDLINE DCOM- 20210520 LR - 20220907 IS - 2044-6055 (Electronic) IS - 2044-6055 (Linking) VI - 11 IP - 4 DP - 2021 Apr 9 TI - Are medical record front page data suitable for risk adjustment in hospital performance measurement? Development and validation of a risk model of in-hospital mortality after acute myocardial infarction. PG - e045053 LID - 10.1136/bmjopen-2020-045053 [doi] LID - e045053 AB - OBJECTIVES: To develop a model of in-hospital mortality using medical record front page (MRFP) data and assess its validity in case-mix standardisation by comparison with a model developed using the complete medical record data. DESIGN: A nationally representative retrospective study. SETTING: Representative hospitals in China, covering 161 hospitals in modelling cohort and 156 hospitals in validation cohort. PARTICIPANTS: Representative patients admitted for acute myocardial infarction. 8370 patients in modelling cohort and 9704 patients in validation cohort. PRIMARY OUTCOME MEASURES: In-hospital mortality, which was defined explicitly as death that occurred during hospitalisation, and the hospital-level risk standardised mortality rate (RSMR). RESULTS: A total of 14 variables were included in the model predicting in-hospital mortality based on MRFP data, with the area under receiver operating characteristic curve of 0.78 among modelling cohort and 0.79 among validation cohort. The median of absolute difference between the hospital RSMR predicted by hierarchical generalised linear models established based on MRFP data and complete medical record data, which was built as 'reference model', was 0.08% (10th and 90th percentiles: -1.8% and 1.6%). In the regression model comparing the RSMR between two models, the slope and intercept of the regression equation is 0.90 and 0.007 in modelling cohort, while 0.85 and 0.010 in validation cohort, which indicated that the evaluation capability from two models were very similar. CONCLUSIONS: The models based on MRFP data showed good discrimination and calibration capability, as well as similar risk prediction effect in comparison with the model based on complete medical record data, which proved that MRFP data could be suitable for risk adjustment in hospital performance measurement. CI - (c) Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. FAU - Wu, Chaoqun AU - Wu C AD - National Clinical Research Center of Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China. FAU - Zhang, Danwei AU - Zhang D AD - National Clinical Research Center of Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China. FAU - Bai, Xueke AU - Bai X AD - National Clinical Research Center of Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China. FAU - Zhou, Tiannan AU - Zhou T AD - Center for Outcomes Research and Evaluation, Yale-New Haven Health System, New Haven, Connecticut, USA. FAU - Wang, Yongfei AU - Wang Y AD - Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA. FAU - Lin, Zhenqiu AU - Lin Z AD - Center for Outcomes Research and Evaluation, Yale-New Haven Health System, New Haven, Connecticut, USA. FAU - He, Guangda AU - He G AD - National Clinical Research Center of Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China. FAU - Li, Xi AU - Li X AUID- ORCID: 0000-0003-2249-688X AD - National Clinical Research Center of Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China xi.li@fwoxford.org. CN - China PEACE Collaborative Group LA - eng GR - T35 AG049685/AG/NIA NIH HHS/United States PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20210409 PL - England TA - BMJ Open JT - BMJ open JID - 101552874 SB - IM MH - China/epidemiology MH - Hospital Mortality MH - Hospitals MH - Humans MH - Medical Records MH - *Myocardial Infarction MH - Retrospective Studies MH - *Risk Adjustment PMC - PMC8043007 OTO - NOTNLM OT - health informatics OT - myocardial infarction OT - quality in health care COIS- Competing interests: None declared. FIR - Weng, Shiping IR - Weng S FIR - Xie, Shuying IR - Xie S FIR - Wu, Lirong IR - Wu L FIR - Chen, Jiulin IR - Chen J FIR - Li, Tianfa IR - Li T FIR - Wang, Jun IR - Wang J FIR - Yu, Qin IR - Yu Q FIR - Li, Xiaofei IR - Li X FIR - Li, Zhong IR - Li Z FIR - Hao, Shiguo IR - Hao S FIR - Zhang, Yuzhen IR - Zhang Y FIR - Wu, Xuemei IR - Wu X FIR - Zhang, Yachen IR - Zhang Y FIR - Liu, Zhifeng IR - Liu Z FIR - Wang, Zhongxin IR - Wang Z FIR - Jia, Hao IR - Jia H FIR - Bate, Bayin IR - Bate B FIR - Qiqige, Badeng IR - Qiqige B FIR - Jin, Xiang IR - Jin X FIR - Cai, Ting IR - Cai T FIR - Liu, Fengqin IR - Liu F FIR - Xu, Dayong IR - Xu D FIR - He, Xuejin IR - He X FIR - Yang, Shui IR - Yang S FIR - Yuan, Chun IR - Yuan C FIR - Wang, Jiping IR - Wang J FIR - Gu, Lihua IR - Gu L FIR - Li, Lin IR - Li L FIR - Chen, Shijiao IR - Chen S FIR - Zhi, Yongchao IR - Zhi Y FIR - Sun, Lili IR - Sun L FIR - Zhou, Shengcheng IR - Zhou S FIR - Jin, Lingjiao IR - Jin L FIR - Leng, Yong IR - Leng Y FIR - Zhang, Liangchuan IR - 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10.1136/bmjopen-2020-045053 [doi] PST - epublish SO - BMJ Open. 2021 Apr 9;11(4):e045053. doi: 10.1136/bmjopen-2020-045053.