title: A European benchmarking system to evaluate in-hospital mortality rates in acute coronary syndrome: the EURHOBOP project.
abstract: BACKGROUND
  Hospital performance models in acute myocardial infarction (AMI) are useful to assess patient management. While models are available for individual countries, mainly US, cross-European performance models are lacking. Thus, we aimed to develop a system to benchmark European hospitals in AMI and percutaneous coronary intervention (PCI), based on predicted in-hospital mortality.
  
  
  RESULTS
  We used the EURopean HOspital Benchmarking by Outcomes in ACS Processes (EURHOBOP) cohort to develop the models, which included 11,631 AMI patients and 8276 acute coronary syndrome (ACS) patients who underwent PCI. Models were validated with a cohort of 55,955 European ACS patients. Multilevel logistic regression was used to predict in-hospital mortality in European hospitals for AMI and PCI. Administrative and clinical models were constructed with patient- and hospital-level covariates, as well as hospital- and country-based random effects. Internal cross-validation and external validation showed good discrimination at the patient level and good calibration at the hospital level, based on the C-index (0.736-0.819) and the concordance correlation coefficient (55.4%-80.3%). Mortality ratios (MRs) showed excellent concordance between administrative and clinical models (97.5% for AMI and 91.6% for PCI). Exclusion of transfers and hospital stays ≤1day did not affect in-hospital mortality prediction in sensitivity analyses, as shown by MR concordance (80.9%-85.4%). Models were used to develop a benchmarking system to compare in-hospital mortality rates of European hospitals with similar characteristics.
  
  
  CONCLUSIONS
  The developed system, based on the EURHOBOP models, is a simple and reliable tool to compare in-hospital mortality rates between European hospitals in AMI and PCI.
authors: REGICOR Study Group, Cardiovascular Epidemiology and Genetics Group, IMIM, Hospital del Mar Medical Research Institute, Barcelona, Spain.
authors: Irene R
authors: IR
authors: Dégano
authors: REGICOR Study Group, Cardiovascular Epidemiology and Genetics Group, IMIM, Hospital del Mar Medical Research Institute, Barcelona, Spain; CIBER Epidemiology and Public Health, Spain.
authors: Isaac
authors: I
authors: Subirana
authors: Istituto Superiore di Sanità, Rome, Italy.
authors: Marina
authors: M
authors: Torre
authors: REGICOR Study Group, Cardiovascular Epidemiology and Genetics Group, IMIM, Hospital del Mar Medical Research Institute, Barcelona, Spain.
authors: María
authors: M
authors: Grau
authors: REGICOR Study Group, Cardiovascular Epidemiology and Genetics Group, IMIM, Hospital del Mar Medical Research Institute, Barcelona, Spain; CIBER Epidemiology and Public Health, Spain.
authors: Joan
authors: J
authors: Vila
authors: Dipartimento di Epidemiologia ASL RME, Rome, Italy.
authors: Danilo
authors: D
authors: Fusco
authors: MONICA/KORA Myocardial Infarction Registry, Augsburg, Germany; Helmholtz Zentrum München, German Research Center for Environmental Health, Institute for Epidemiology II, Neuherberg, Germany.
authors: Inge
authors: I
authors: Kirchberger
authors: Department of Cardiology, Toulouse Rangueil Hospital, Toulouse University School of Medicine, Toulouse, France.
authors: Jean
authors: J
authors: Ferrières
authors: Centre for Health and Social Economics, Helsinki, Finland.
authors: Antti
authors: A
authors: Malmivaara
authors: Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Institute of Public Health of the University of Porto (ISPUP), Porto, Portugal.
authors: Ana
authors: A
authors: Azevedo
authors: MONICA/KORA Myocardial Infarction Registry, Augsburg, Germany; Helmholtz Zentrum München, German Research Center for Environmental Health, Institute for Epidemiology II, Neuherberg, Germany.
authors: Christa
authors: C
authors: Meisinger
authors: Department of Epidemiology, UMR 1027 INSERM, Toulouse University, Toulouse, France.
authors: Vanina
authors: V
authors: Bongard
authors: ATTIKON Hospital, University of Athens Medical School, Athens, Greece.
authors: Dimitros
authors: D
authors: Farmakis
authors: Dipartimento di Epidemiologia ASL RME, Rome, Italy.
authors: Marina
authors: M
authors: Davoli
authors: Centre for Health and Social Economics, Helsinki, Finland.
authors: Unto
authors: U
authors: Häkkinen
authors: Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Institute of Public Health of the University of Porto (ISPUP), Porto, Portugal.
authors: Carla
authors: C
authors: Araújo
authors: ATTIKON Hospital, University of Athens Medical School, Athens, Greece.
authors: John
authors: J
authors: Lekakis
authors: REGICOR Study Group, Cardiovascular Epidemiology and Genetics Group, IMIM, Hospital del Mar Medical Research Institute, Barcelona, Spain.
authors: Roberto
authors: R
authors: Elosua
authors: REGICOR Study Group, Cardiovascular Epidemiology and Genetics Group, IMIM, Hospital del Mar Medical Research Institute, Barcelona, Spain. Electronic address: jmarrugat@imim.es.
authors: Jaume
authors: J
authors: Marrugat
mesh_terms: D054058:Acute Coronary Syndrome / Q000401:mortality* / Q000601:surgery; D019985:Benchmarking; D005060:Europe / Q000453:epidemiology; D017052:Hospital Mortality / Q000639:trends; D006761:Hospitals / Q000592:standards*; D006801:Humans; D062645:Percutaneous Coronary Intervention; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*
keywords: Acute myocardial infarction; Benchmarking; Hospital performance; In-hospital mortality; Percutaneous coronary intervention