title: Risk-Adjusted In-Hospital Mortality Models for Congestive Heart Failure and Acute Myocardial Infarction: Value of Clinical Laboratory Data and Race/Ethnicity.
abstract: OBJECTIVE
  To examine the impact of key laboratory and race/ethnicity data on the prediction of in-hospital mortality for congestive heart failure (CHF) and acute myocardial infarction (AMI).
  
  
  METHODS
  Hawaii adult hospitalizations database between 2009 and 2011, linked to laboratory database.
  
  
  METHODS
  Cross-sectional design was employed to develop risk-adjusted in-hospital mortality models among patients with CHF (n = 5,718) and AMI (n = 5,703).
  
  
  METHODS
  Results of 25 selected laboratory tests were requested from hospitals and laboratories across the state and mapped according to Logical Observation Identifiers Names and Codes standards. The laboratory data were linked to administrative data for each discharge of interest from an all-payer database, and a Master Patient Identifier was used to link patient-level encounter data across hospitals statewide.
  
  
  RESULTS
  Adding a simple three-level summary measure based on the number of abnormal laboratory data observed to hospital administrative claims data significantly improved the model prediction for inpatient mortality compared with a baseline risk model using administrative data that adjusted only for age, gender, and risk of mortality (determined using 3M's All Patient Refined Diagnosis Related Groups classification). The addition of race/ethnicity also improved the model.
  
  
  CONCLUSIONS
  The results of this study support the incorporation of a simple summary measure of laboratory data and race/ethnicity information to improve predictions of in-hospital mortality from CHF and AMI. Laboratory data provide objective evidence of a patient's condition and therefore are accurate determinants of a patient's risk of mortality. Adding race/ethnicity information helps further explain the differences in in-hospital mortality.
authors.affiliation: Biostatistics and Data Management Core, University of Hawaii John A. Burns School of Medicine, Honolulu, HI.
authors.forename: Eunjung
authors.initials: E
authors.lastname: Lim
authors.affiliation: Biostatistics and Data Management Core, University of Hawaii John A. Burns School of Medicine, Honolulu, HI.
authors.forename: Yongjun
authors.initials: Y
authors.lastname: Cheng
authors.affiliation: Hawaii Health Information Corporation, Honolulu, HI.
authors.forename: Christine
authors.initials: C
authors.lastname: Reuschel
authors.affiliation: Biostatistics and Data Management Core, University of Hawaii John A. Burns School of Medicine, Honolulu, HI.
authors.forename: Omar
authors.initials: O
authors.lastname: Mbowe
authors.affiliation: Biostatistics and Data Management Core, University of Hawaii John A. Burns School of Medicine, Honolulu, HI.
authors.forename: Hyeong Jun
authors.initials: HJ
authors.lastname: Ahn
authors.affiliation: University of Hawaii College of Pharmacy, Honolulu, HI.
authors.forename: Deborah T
authors.initials: DT
authors.lastname: Juarez
authors.affiliation: Hawaii Health Information Corporation, Honolulu, HI.
authors.forename: Jill
authors.initials: J
authors.lastname: Miyamura
authors.affiliation: University of Hawaii John A. Burns School of Medicine and the Queen's Medical Center, Honolulu, HI.
authors.forename: Todd B
authors.initials: TB
authors.lastname: Seto
authors.affiliation: Biostatistics and Data Management Core, University of Hawaii John A. Burns School of Medicine, Honolulu, HI.
authors.forename: John J
authors.initials: JJ
authors.lastname: Chen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002984:Clinical Laboratory Information Systems / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006254:Hawaii / Q000453:epidemiology; D006302:Health Services Research; D006333:Heart Failure / Q000208:ethnology* / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000208:ethnology* / Q000401:mortality*; D044469:Racial Groups / Q000706:statistics & numerical data*; D020379:Risk Adjustment / Q000379:methods*
keywords: In-hospital mortality; acute myocardial infarction; congestive heart failure; risk-adjusted model