title: Use of cumulative mortality data in patients with acute myocardial infarction for early detection of variation in clinical practice: observational study.
abstract: OBJECTIVE
  Use of cumulative mortality adjusted for case mix in patients with acute myocardial infarction for early detection of variation in clinical practice.
  
  
  METHODS
  Observational study.
  
  
  METHODS
  20 hospitals across the former Yorkshire region.
  
  
  METHODS
  All 2153 consecutive patients with confirmed acute myocardial infarction identified during three months.
  
  
  METHODS
  Variable life-adjusted 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 life-adjusted 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 life-adjusted display has been integrated into surgical care as a graphical display of risk-adjusted 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.
authors.affiliation: BHF Heart Research Centre, Leeds General Infirmary Leeds LS2 9JT.
authors.forename: R A
authors.initials: RA
authors.lastname: Lawrance
authors.forename: M F
authors.initials: MF
authors.lastname: Dorsch
authors.forename: R J
authors.initials: RJ
authors.lastname: Sapsford
authors.forename: A F
authors.initials: AF
authors.lastname: Mackintosh
authors.forename: D C
authors.initials: DC
authors.lastname: Greenwood
authors.forename: B M
authors.initials: BM
authors.lastname: Jackson
authors.forename: C
authors.initials: C
authors.lastname: Morrell
authors.forename: M B
authors.initials: MB
authors.lastname: Robinson
authors.forename: A S
authors.initials: AS
authors.lastname: Hall
mesh_terms: D000367:Age Factors; D001794:Blood Pressure; D002985:Clinical Protocols / Q000592:standards*; D003325:Coronary Care Units; D006339:Heart Rate; D006767:Hospitals, District; D006801:Humans; D009203:Myocardial Infarction / Q000401:mortality*; D020379:Risk Adjustment; D018570:Risk Assessment / Q000379:methods*; D015996:Survival Rate; D013599:Systole