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Mass-DAC List of Publications

  1. Barringhaus KG, Zelevinsky K, Lovett A, Normand S-LT, Ho KKL
    Impact of Independent Data Adjudication on Hospital-Specific Estimates of Risk-Adjusted Mortality Following Percutaneous Coronary Interventions in Massachusetts
    Circulation: Cardiovascular Quality and Outcomes     2011     4     92-98     Link to Publication
    Background— As part of state-mandated public reporting of outcomes after percutaneous coronary interventions (PCIs) in Massachusetts, procedural and clinical data were prospectively collected. Variables associated with higher mortality were audited to ensure accuracy of coding. We examined the impact of adjudication on identifying hospitals with possible deficiencies in the quality of PCI care. Methods and Results— From October 2005 to September 2006, 15 721 admissions for PCI occurred in 21 hospitals. Of the 864 high-risk variables from 822 patients audited by committee, 201 were changed, with reassignment to lower acuities in 97 (30%) of the 321 shock cases, 24 (43%) of the 56 salvage cases, and 73 (15%) of the 478 emergent cases. Logistic regression models were used to predict patient-specific in-hospital mortality. Of 241 (1.5%) patients who died after PCI, 30 (12.4%) had a lower predicted mortality with adjudicated than with unadjudicated data. Model accuracy was excellent with either adjudicated or unadjudicated data. Hospital-specific risk-standardized mortality rates were estimated using both adjudicated and unadjudicated data through hierarchical logistic regression. Although adjudication reduced between-hospital variation by one third, risk-standardized mortality rates were similar using unadjudicated and adjudicated data. None of the hospitals were identified as statistical outliers. However, cross-validated posterior-predicted P values calculated with adjudicated data increased the number of borderline hospital outliers compared with unadjudicated data. Conclusions— Independent adjudication of site-reported high-risk features may increase the ability to identify hospitals with higher risk-adjusted mortality after PCI despite having little impact on the accuracy of risk prediction for the entire population.
  2. Peterson ED
    Editorial: The Need for "Compassionate Provider Profiling": Refining Risk Assessment for Percutaneous Coronary Intervention
    Journal of the American College of Cardiology     2011     57     912-913     Link to Publication
    In today’s “transparent” society, the public is increasingly demanding more information on the quality and outcomes of medical care (1,2). Most would agree that patients need more data regarding their health care providers’ results, yet the devil is always in the details. For outcome comparisons to be fair and valid, they first need to be adjusted for underlying patient risks (3). For percutaneous coronary intervention (PCI), outcome metrics (e.g., acute mortality) must account for multiple potential confounding factors including patient demographics, disease severity, comorbid illness, and, most importantly, procedural acuity.
  3. Resnic FS, Normand S-LT, Piemonte TC, Shubrooks SJ, Zelevinsky K, Lovett A, Ho KKL
    Improvement in Mortality Risk Prediction After Percutaneous Coronary Intervention Through the Addition of a "Compassionate Use" Variable to the National Cardiovascular Data Registry CathPCI Dataset: A Study From the Massachusetts Angioplasty Registry
    Journal of the American College of Cardiology     2011     57     904-911     Link to Publication
    Objectives: This study investigated the impact of adding novel elements to models predicting in-hospital mortality after percutaneous coronary interventions (PCIs). Conclusions: A small proportion of patients at extreme risk of post-PCI mortality can be identified using pre-procedural factors not routinely collected, but that heighten predictive accuracy. Such improvements in model performance may result in greater confidence in reporting of risk-adjusted PCI outcomes.
  4. Yeh RW, Normand S-LT, Wolf RE, Jones PG, Ho KKL, Cohen DJ, Cutlip DE, Mauri L, Kugelmass AD, Amin AP, Spertus JA
    Predicting the Restenosis Benefit of Drug-Eluting Versus Bare Metal Stents in Percutaneous Coronary Intervention
    Circulation     2011     DOI: 10.1161/CIRCULATIONAHA.111.045229     Link to Publication
  5. Stevens L-M, Khairy P, Agnihotri AK
    Coronary Artery Bypass Grafting After Recent or Remote Percutaneous Coronary Intervention in the Commonwealth of Massachusetts
    Circulation: Cardiovascular Interventions     2010     3     460-467     Link to Publication
    Background— In this study, we sought to characterize the outcomes after isolated coronary artery bypass grafting (CABG) in patients with a history of remote (≥14 days), and recent (<14 days), percutaneous coronary intervention (PCI). Methods and Results— Patients with PCI within 5 years of CABG were identified among 12 591 primary isolated CABG reported in the mandatory Massachusetts Adult Cardiac Surgery Database. Patients were excluded if they were out-of-state (n=1043, 8%), had undergone primary PCI for acute myocardial infarction (n=401, 3%), had a PCI-CABG interval >5 years or unknown (n=136 and n=673, 1% and 5%). Patients with a history of remote and recent PCI were analyzed separately. Each CABG patient with PCI was matched to 3 patients without PCI using a propensity score. Outcomes were analyzed using generalized estimating equations and stratified proportional hazards models, with a mean follow-up of 4.1±1.2 years. There were 1117 CABG patients (9%) with prior PCI (nremote=823; nrecent=294). In matched CABG patients with remote prior PCI, no differences were found in 30-day mortality (1.1% versus 1.5%; P=0.432), hospital morbidity (41% versus 40%; P=0.385) and overall survival (hazard ratio, [95% confidence interval] for death for prior PCI, 0.93 [0.74 to 1.18]; P=0.555). In matched CABG patients with recent prior PCI, hospital morbidity was higher (59% versus 45%; P<0.001), but no differences were found in 30-day mortality (3.5% versus 3.1%; P=0.754) and overall survival (HR, 1.18 [0.83 to 1.69]; P=0.353). Conclusions— In patients undergoing CABG, remote prior PCI (≥14 days) was not associated with adverse outcomes at 30 days or during long-term follow-up.
  6. Castellanos LR, Normand S-LT, Ayanian JZ
    Racial and Ethnic Disparities in Access to Higher and Lower Quality Cardiac Surgeons for Coronary Artery Bypass Grafting
    The American Journal of Cardiology     2009     103     1682-1686     Link to Publication
    To determine whether Hispanic and African-American patients are treated by cardiac surgeons with better or worse risk-standardized outcomes than surgeons of white patients, clinical data from the Massachusetts Data Analysis Center Registry were analyzed on all patients who underwent isolated coronary artery bypass grafting (CABG) from 2002 to 2004 by surgeons who performed >10 operations. Surgeons were divided into 4 groups based on their risk-standardized 30-day all-cause mortality incidence rates (top decile, top quartile, bottom quartile, and bottom decile). A total of 12,973 isolated CABGs were performed by 56 surgeons for 11,800 whites (91%), 413 Hispanics (3.2%), and 251 African- Americans (1.9%). White patients were more likely to be treated by surgeons in the top decile than by surgeons in the bottom decile (odds ratio [OR] 1.37, 95% confidence interval [CI] 1.07 to 1.76). In contrast, Hispanic patients were almost 3 times more likely to be treated by surgeons in the bottom decile compared with the top decile (OR 2.85, 95% CI 1.82 to 4.47). Compared with whites, Hispanic patients were about 1/2 as less likely to be treated by surgeons in the top decile (OR 0.51, 95% CI 0.35 to 0.75). African-American and white patients were similarly likely to be treated by surgeons in the top- and bottom-quality performance groups. In conclusion, Hispanics undergoing isolated CABG in Massachusetts were more likely to be operated on by cardiac surgeons with higher risk-standardized mortality rates than by surgeons with lower rates.
  7. Garg P, Normand S-LT, Silbaugh TS, Wolf RE, Zelevinsky K, Lovett A, Varma MR, Zhou Z, Mauri L
    Drug-eluting or bare metal stenting in patients with diabetes mellitus: Results from the Mass-DAC registry
    Circulation     2008     118     2277-2285     Link to Publication
  8. Mauri L, Silbaugh TS, Garg P, Wolf RE, Zelevinsky K, Lovett A, Varma MR, Zhou Z, Normand S-LT
    Drug-eluting or bare-metal stents for acute myocardial infarction
    New England Journal of Medicine     2008     359(13)     1330-1342     Link to Publication
  9. Mauri L, Silbaugh TS, Wolf RE, Zelevinsky K, Lovett A, Zhou Z, Resnic FS, Normand S-LT
    Long-term clinical outcomes following drug-eluting and bare metal stenting in Massachusetts
    Circulation     2008     118     1817-1827     Link to Publication
  10. Normand S-LT
    Some old and some new statistical tools for outcomes research
    Circulation     2008     118(8)     872-884     Link to Publication
  11. Shahian DM, Normand S-LT
    The comparison of "risk-adjusted" hospital outcomes
    Circulation     2008     117     1955-1963     Link to Publication
  12. Normand S-LT , Shahian DM
    Statistical and clinical aspects of institutional profiling
    Statistical Science     2007     22(2)     206-226
  13. Shahian DM, Silverstein T, Lovett AF, Wolf RE, Normand S-LT
    Comparison of clinical and administrative data sources for hospital coronary artery bypass graft surgery report cards
    Circulation     2007     115     1518-1527     Link to Publication
  14. Shahian DM, Torchiana DF, Normand S-LT
    Implementation of a cardiac surgery report card
    Annals of Thoracic Surgery     2005     80     1146-1180     Link to Publication
  15. Shahian DM, Torchiana DF, Shemin RJ, Rawn JD, Normand, S-LT
    The Massachusetts cardiac surgery report card: implications of statistical methodology
    Annals of Thoracic Surgery     2005     80     2106-2113     Link to Publication
  16. Shahian DM, Normand S-LT
    The volume-outcome relationship: From Luft to Leapfrog
    Annals of Thoracic Surgery     2003     75     1048-1058     Link to Publication
  17. Shahian DM, Normand S-LT, Torchiana DF, Lewis SM, Pastore JO, Kuntz RE, Dreyer PL
    Cardiac surgery report cards: Comprehensive review and statistical critique
    Annals of Thoracic Surgery     2001     72(6)     2155-2168     Link to Publication