Use of cumulative mortality data in patients with acute myocardial infarction for early detection of variation in clinical practice: observational study

Lawrance, R.A., Dorsch, M.F., Sapsford, R.J., Mackintosh, A.F., Greenwood, D.C., Jackson, B.M., Morrell, C., Robinson, M.B. and Hall, A.S. (2001) Use of cumulative mortality data in patients with acute myocardial infarction for early detection of variation in clinical practice: observational study. BMJ, 323 (7308). pp. 324-327. ISSN 0959-8138

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Abstract

OBJECTIVES: Use of cumulative mortality adjusted for case mix in patients with acute myocardial infarction for early detection of variation in clinical practice.

DESIGN: Observational study.

SETTING: 20 hospitals across the former Yorkshire region.

PARTICIPANTS: All 2153 consecutive patients with confirmed acute myocardial infarction identified during three months.

MAIN OUTCOME MEASURES: Variable life­adjusted displays showing cumulative differences between observed and expected mortality of patients; expected mortality calculated from risk model based on admission characteristics of age, heart rate, and systolic blood pressure.

RESULTS: The performance of two individual hospitals over three months was examined as an example. One, the smallest district hospital in the region, had a series of 30 consecutive patients but had five more deaths than predicted. The variable life­adjusted display showed minimal variation from that predicted for the first 15 patients followed by a run of unexpectedly high mortality. The second example was the main tertiary referral centre for the region, which admitted 188 consecutive patients. The display showed a period of apparently poor performance followed by substantial improvement, where the plot rose steadily from a cumulative net lives saved of - 4 to 7. These variations in patient outcome are unlikely to have been revealed during conventional audit practice.

CONCLUSIONS: Variable life­adjusted display has been integrated into surgical care as a graphical display of risk­adjusted survival for individual surgeons or centres. In combination with a simple risk model, it may have a role in monitoring performance and outcome in patients with acute myocardial infarction.

Item Type:	Article
Copyright, Publisher and Additional Information:	© BMJ 2001
Academic Units:	The University of Leeds > Faculty of Medicine and Health (Leeds) > Leeds Institute of Genetics, Health and Therapeutics (LIGHT) > Academic Unit of Cardiovascular Medicine (Leeds) The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) > Leeds Institute of Genetics, Health and Therapeutics (LIGHT) > Academic Unit of Cardiovascular Medicine (Leeds) The University of Leeds > Faculty of Medicine and Health (Leeds) > Institute of Health Sciences (Leeds) The University of Leeds > Faculty of Medicine and Health (Leeds) > Leeds Institute of Genetics, Health and Therapeutics (LIGHT) > Biostatistics (Leeds) The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) > Leeds Institute of Genetics, Health and Therapeutics (LIGHT) > Biostatistics (Leeds)
Depositing User:	Repository Officer
Date Deposited:	14 Mar 2006
Last Modified:	08 Feb 2013 17:01
Published Version:	http://bmj.com/cgi/content/full/323/7308/324
Status:	Published
Refereed:	Yes
Identification Number:	10.1136/bmj.323.7308.324
URI:	http://eprints.whiterose.ac.uk/id/eprint/159

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