Fadi Adel, Connor D Walsh, John Bretzman, Philip Sang, Kyla Lara-Breitinger, Madeline Mahowald, Arvind Maheshwari, Christopher G Scott, Alexander T Lee, Caroline J Davidge-Pitts, Patricia A Pellikka, Rekha Mankad
Transgender Women Exhibit a Distinct Stress Echocardiography Profile Compared to Age-Matched Cisgender Counterparts: The Mayo Clinic Women's Heart Clinic Experience
Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography
failure rescue ftr inpatient death following complication publicly reported hospital quality measure previous work demonstrated significant variation proportion frail patients across hospitals however frailty incorporated riskadjustment algorithms hospital quality comparisons risk adjustment made comorbidity scores aim assess impact frailty ftr quality measurement means risk adjustment patients undergoing open endovascular aneurysm repair lower extremity bypass vascular quality initiative vqi centers performing 25 vascular procedures annually 20032019 included multivariable logistic regression evaluated inhospital death using scaled hierarchical modeling clustering center level center ftr observedexpected ratios compared expected values adjusted either standard comorbidity profiles frailty measured vqi risk analysis index centers divided quartiles using vqilinked american hospital association data describe hospital characteristics centers whose ranks changed total 63143 patients 213 centers included 1630 patients 258 classified ftr accounting centerlevel variability frailty associated ftr scaled odds ratio 19 1820 p 0001 comorbiditycentric frailtybased models performed similarly predicting ftr cstatistics 085 084086 082 082084 respectively overall changes ranking based observedexpected ratios statistically significant p 048 high low performing centers similar ranking using comorbiditycentric frailtybased methods however centers middle performance spectrum saw variability ranking alterations forty nine 23 hospitals improved ranking five positions using frailty versus comorbidity risk adjustment centers quartile 4 performed highest number vascular procedures annually experience average significant improvement hospital ranking frailty used risk adjustment whereas centers performing fewest number vascular procedures lowest proportion vascular surgery cases annually quartile 1 saw significant worsening ranking position p 005 however total number surgical procedures annually total hospital beds forprofit status teaching hospital status significantly associated changes rank simple frailtyadjusted model similar predictive abilities comorbidityfocused model predicting common quality metric influences reimbursement addition distilling riskadjustment algorithm variables frailty assessed preoperatively develop quality improvement efforts rescuing frail patients centers treating greater proportion frail patients perform higher volumes vascular surgery benefit risk adjustment strategy based frailty