title: Catheterization for Congenital Heart Disease Adjustment for Risk Method (CHARM).
abstract: OBJECTIVE
  This study sought to develop a method to adjust for case mix complexity in catheterization for congenital heart disease to allow equitable comparisons of adverse event (AE) rates.
  
  
  BACKGROUND
  The C3PO (Congenital Cardiac Catheterization Project on Outcomes) has been prospectively collecting data using a Web-based data entry tool on all catheterization cases at 8 pediatric institutions since 2007.
  
  
  METHODS
  A multivariable logistic regression model with high-severity AE outcome was built using a random sample of 75% of cases in the multicenter cohort; the models were assessed in the remaining 25%. Model discrimination was assessed by the C-statistic and calibration with Hosmer-Lemeshow test. The final models were used to calculate standardized AE ratios.
  
  
  RESULTS
  Between August 2007 and December 2009, 9,362 cases were recorded at 8 pediatric institutions of which high-severity events occurred in 454 cases (5%). Assessment of empirical data yielded 4 independent indicators of hemodynamic vulnerability. Final multivariable models included procedure type risk category (odds ratios [OR] for category: 2 = 2.4, 3 = 4.9, 4 = 7.6, all p < 0.001), number of hemodynamic indicators (OR for 1 indicator = 1.5, ≥2 = 1.8, p = 0.005 and p < 0.001), and age <1 year (OR: 1.3, p = 0.04), C-statistic 0.737, and Hosmer-Lemeshow test p = 0.74. Models performed well in the validation dataset, C-statistic 0.734. Institutional event rates ranged from 1.91% to 7.37% and standardized AE ratios ranged from 0.61 to 1.41.
  
  
  CONCLUSIONS
  Using CHARM (Catheterization for Congenital Heart Disease Adjustment for Risk Method) to adjust for case mix complexity should allow comparisons of AE among institutions performing catheterization for congenital heart disease.
authors.affiliation: Department of Cardiology, The Children's Hospital, Boston, Massachusetts, USA. lisa.bergersen@cardio.chboston.org
authors.forename: Lisa
authors.initials: L
authors.lastname: Bergersen
authors.forename: Kimberlee
authors.initials: K
authors.lastname: Gauvreau
authors.forename: Susan R
authors.initials: SR
authors.lastname: Foerster
authors.forename: Audrey C
authors.initials: AC
authors.lastname: Marshall
authors.forename: Doff B
authors.initials: DB
authors.lastname: McElhinney
authors.forename: Robert H
authors.initials: RH
authors.lastname: Beekman
authors.forename: Russel
authors.initials: R
authors.lastname: Hirsch
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Kreutzer
authors.forename: David
authors.initials: D
authors.lastname: Balzer
authors.forename: Julie
authors.initials: J
authors.lastname: Vincent
authors.forename: William E
authors.initials: WE
authors.lastname: Hellenbrand
authors.forename: Ralf
authors.initials: R
authors.lastname: Holzer
authors.forename: John P
authors.initials: JP
authors.lastname: Cheatham
authors.forename: John W
authors.initials: JW
authors.lastname: Moore
authors.forename: Grant
authors.initials: G
authors.lastname: Burch
authors.forename: Laurie
authors.initials: L
authors.lastname: Armsby
authors.forename: James E
authors.initials: JE
authors.lastname: Lock
authors.forename: Kathy J
authors.initials: KJ
authors.lastname: Jenkins
mesh_terms: D000293:Adolescent; D000367:Age Factors; D006328:Cardiac Catheterization / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006330:Heart Defects, Congenital / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D006439:Hemodynamics; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D020407:Internet; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D014481:United States