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Saint HCM530 case study 4




Question;HCM530;Case Study 4;Risk Adjustment with Multivariate Techniques (New York);The state of New York;( 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.;Logistic Regression;Patient Risk Factor Prevalence (%) Coefficient P-Value Odds;Ratio;Demographics;Age ?. 0.0671 <0.0001 1.069;Female Gender 28.92 0.5105 <0.0001 1.666;Hemodynamic State;Unstable 1.32 1.0423 <0.0001 2.836;Shock 0.45 1.8458 <0.0001 6.333;Comorbidities;Diabetes 30.91 0.3607 0.0010 1.434;Malignant Ventricular Arrhythmia 2.228 0.9759 <0.0001;2.654;COPD 15.97 0.5012 2.5;1.89 0.9213 <0.0001 2.513;Renal Failure requiring Dialysis 1.89 0.9213 <0.0001;5.688;Hepatic Failure 0.10 3.0535 <0.0001 21.190;Severity of Atherosclerotic Process;Aortoiliac Disease 5.42 0.5481 0.0006 1.730;Stroke 7.01 0.4775 0.0016 1.621;Ventricular Function;Ejection Fraction <20 1.77 1.4235 <0.0001 4.151;Ejection Fraction 20-29 7.40 0.8183 <0.0001 2.267;Ejection Fraction 30-39 14.49 0.6186 <0.0001 1.856;Previous Open Heart Operations 5.98 0.6800 <0.0001 1.974;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 mpaper;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?


Paper#58638 | Written in 18-Jul-2015

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