HCM 530 Case Study 4 Risk Adjustment with Multivariate Techniques

HCM 530 Case Study 4 Risk Adjustment

HCM 530 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) hasreported risk adjusted mortality statistics for coronary artery bypass graft surgery (CABG) for a numberof years as discussed earlier in the text. New York uses the second major approach to risk adjustment amultivariate model. Such models control for different kinds of patient characteristics that are likely toinfluence mortality. Table 4.1 reports the multivariate model used to calculate this risk-adjustedmeasure. (Textbook Case Study 6.4)Table 4.1: Multivariable risk factor equation for CABG hospital deaths in New York State in 1998.Logistic RegressionPatient Risk Factor Prevalence (%) Coefficient P-Value Odds Ratio DemographicsAgeFemale Gender ….28.92 0.06710.5105 <0.0001<0.0001 1.0691.666 Hemodynamic StateUnstableShock 1.320.45 1.04231.8458 <0.0001<0.0001 2.8366.333 30.912.22815.97 0.36070.97590.5012 0.0010<0.0001<0.0001 1.4342.6541.651 1.891.890.10 0.92130.92133.0535 <0.0001<0.0001<0.0001 2.5135.68821.190 Severity of Atherosclerotic ProcessAortoiliac DiseaseStroke 5.427.01 0.54810.4775 0.00060.0016 1.7301.621 Ventricular FunctionEjection Fraction <20Ejection Fraction 20-29Ejection Fraction 30-39 1.777.4014.49 1.42350.81830.6186 <0.0001<0.0001<0.0001 4.1512.2671.856 Previous Open Heart Operations 5.98 0.6800 <0.0001 1.974 ComorbiditiesDiabetesMalignant Ventricular ArrhythmiaCOPDRenal Failure (no dialysis) Creatinine > 2.5Renal Failure requiring DialysisHepatic Failure Intercept = -9.4988C Statistic = 0.793 Case Questions: Answer the case questions with research from your book CDC NIH and other qualitysources to determine answers and solutions. You are to write a 2-3 page paper in APA formatting thataddresses the following questions. Note: A minimum of two references should be used which shouldinclude your textbook and the CDC and others that support your responses in your paper. This is apaper 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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