The Need for Risk Adjustment
Every patient who has the need for a Percutaneous Coronary Intervention (PCI – see definition below) procedure has his or her own unique health history.
Liverpool Heart & Chest Hospital uses a published and validated prediction tool to estimate the risk of a PCI resulting in a Major Adverse Cardiac Event (MACE). The term MACE includes death, heart attack, stroke or emergency surgery. This estimated risk is based on each individual patient’s own history.
This system weights the importance of each health fact (Eg. weight, smoker/non-smoker, diabetic/non-diabetic etc) based on the experience of many thousands of patients who have undergone the same procedure in recent years. Health facts that are linked to a high chance of MACE are given much more weight relative to those that are not. These health facts are known as “risk factors”.
By adding up the weights of each of these risk factors, our medical staff can estimate a patient’s individual risk. By summing the risk in all patients operated on at Liverpool Heart & Chest Hospital we can estimate how many patients we predict may suffer MACE based on their health histories. Lastly, by summing how many patients actually suffer MACE and comparing this estimate to our predictions, we can derive a measure of how well our organisation or a particular clinician is performing. The result is a “risk adjusted” estimate of performance.
Risk adjusted estimates are necessary in order to really make sense of results. Without them, hospitals or clinicians that operate on a majority of patients with relatively few risk factors will naturally have better results than those who operate on a majority of patients with many risk factors. Liverpool Heart & Chest Hospital has been deriving risk-adjusted estimates of performance since 1997.
Definition – Percutaneous Coronary Intervention (PCI)
Percutaneous Coronary Intervention is the insertion of a small tube with a balloon tip at either the groin or forearm. The tube is threaded through arteries until it reaches the coronary arteries of the heart. The balloon is then inflated to open the arteries. Once the coronary arteries are open and blood flow is restored, a wire mesh tube (stent) is usually placed in the arteries to keep them open.
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