The Assessment of Severity Adjustment Measures for AMI Patients in Korea

Park, Hyeung-Keun

Journal of Korean Society Quality Assurance Health Care 2003;10(2): 164.
Published online December 30, 2003.

급성심근경색증 환자를 대상으로 한 중증도 보정 방법의 평가

박형근

한국보건산업진흥원

The Assessment of Severity Adjustment Measures for AMI Patients in Korea

Hyeung-Keun Park

Korea Health Industry Development Institute

Abstract

Objectives
To evaluate the performance of models to predict AMI patients death using severity adjustment measures in Korea.
Methods
Medical records of 861 patients treated by AMI in 7 general hospitals during 1996 and 1997 were reviewed by trained nurses. We measured the severity of patients by APACHE III, MedisGroups, CSI and DS. Using each severity method a predictive mortality for each patient was calculated from a logistic regression model including the severity score. The statistical performance of each severity method model was evaluated by using c-statistics and R2. For each hospital, z scores compared actual and expected mortality rates.
Results
The overall in-hospital mortality was 14.5%, ranged from 10.0% to 22.2%. The distributions of severity scores for each method was significantly different by hospitals. The four severity-adjusted models to predict AMI patients death varied in their statistical performance for discrimination power of patients death. Order of Severity-adjusted mortality rates and z scores by four severity measures was different.
Conclusion
Severity-adjusted mortality rates of AMI patients might be applied as an indicator for hospital performance evaluation in Korea. Because different severity methods frequently produce different impressions about relative hospital performance, more studies has to be done to use it as quality indicator and more attention should be paid to select appropriate severity measures.

Key words risk adjustment;AMI;mortality;