title: Development and Validation of an Agency for Healthcare Research and Quality Indicator for Mortality After Congenital Heart Surgery Harmonized With Risk Adjustment for Congenital Heart Surgery (RACHS-1) Methodology.
abstract: The National Quality Forum previously approved a quality indicator for mortality after congenital heart surgery developed by the Agency for Healthcare Research and Quality (AHRQ). Several parameters of the validated Risk Adjustment for Congenital Heart Surgery (RACHS-1) method were included, but others differed. As part of the National Quality Forum endorsement maintenance process, developers were asked to harmonize the 2 methodologies.
  
  
  
  Parameters that were identical between the 2 methods were retained. AHRQ's Healthcare Cost and Utilization Project State Inpatient Databases (SID) 2008 were used to select optimal parameters where differences existed, with a goal to maximize model performance and face validity. Inclusion criteria were not changed and included all discharges for patients <18 years with International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes for congenital heart surgery or nonspecific heart surgery combined with congenital heart disease diagnosis codes. The final model includes procedure risk group, age (0-28 days, 29-90 days, 91-364 days, 1-17 years), low birth weight (500-2499 g), other congenital anomalies (Clinical Classifications Software 217, except for 758.xx), multiple procedures, and transfer-in status. Among 17 945 eligible cases in the SID 2008, the c statistic for model performance was 0.82. In the SID 2013 validation data set, the c statistic was 0.82. Risk-adjusted mortality rates by center ranged from 0.9% to 4.1% (5th-95th percentile).
  
  
  
  Congenital heart surgery programs can now obtain national benchmarking reports by applying AHRQ Quality Indicator software to hospital administrative data, based on the harmonized RACHS-1 method, with high discrimination and face validity.
authors.affiliation: Boston Children's Hospital, Boston, MA kathy.jenkins@childrens.harvard.edu.
authors.forename: Kathy J
authors.initials: KJ
authors.lastname: Jenkins
authors.affiliation: Boston Children's Hospital, Boston, MA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Koch Kupiec
authors.affiliation: Agency for Healthcare Research and Quality, Rockville, MD.
authors.forename: Pamela L
authors.initials: PL
authors.lastname: Owens
authors.affiliation: University of California Davis School of Medicine, Sacramento, CA.
authors.forename: Patrick S
authors.initials: PS
authors.lastname: Romano
authors.affiliation: Battelle Memorial Institute, Columbus, OH.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Geppert
authors.affiliation: Boston Children's Hospital, Boston, MA.
authors.forename: Kimberlee
authors.initials: K
authors.lastname: Gauvreau
mesh_terms: D000293:Adolescent; D000367:Age Factors; D019985:Benchmarking; D006348:Cardiac Surgical Procedures; D002648:Child; D002675:Child, Preschool; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D009026:Mortality; D019984:Quality Indicators, Health Care; D018570:Risk Assessment; D014481:United States; D016270:United States Agency for Healthcare Research and Quality
keywords: congenital heart defects; mortality; pediatrics; risk factors