Benchmarking in Congenital Heart Surgery Using Machine Learning-Derived Optimal Classification Trees
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PAPER 2 SUBMISION PROOF.pdf
Description
Submitted version
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2.36 MB
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Author(s)
Bertsimas, Dimitris
Zhuo, Daisy
Levine, Jordan
Dunn, Jack
Tobota, Zdzislaw
Maruszewski, Bohdan
Fragata, Jose
Sarris, George E
Date Issued
2022
Journal
World Journal for Pediatric and Congenital Heart Surgery
Publisher
SAGE Publications
Citation
Bertsimas, Dimitris, Zhuo, Daisy, Levine, Jordan, Dunn, Jack, Tobota, Zdzislaw et al. 2022. "Benchmarking in Congenital Heart Surgery Using Machine Learning-Derived Optimal Classification Trees." World Journal for Pediatric and Congenital Heart Surgery, 13 (1).
Version
Original manuscript
Abstract
Background: We have previously shown that the machine learning methodology of optimal classification trees (OCTs) can accurately predict risk after congenital heart surgery (CHS). We have now applied this methodology to define benchmarking standards after CHS, permitting case-adjusted hospital-specific performance evaluation. Methods: The European Congenital Heart Surgeons Association Congenital Database data subset (31 792 patients) who had undergone any of the 10 “benchmark procedure group” primary procedures were analyzed. OCT models were built predicting hospital mortality (HM), and prolonged postoperative mechanical ventilatory support time (MVST) or length of hospital stay (LOS), thereby establishing case-adjusted benchmarking standards reflecting the overall performance of all participating hospitals, designated as the “virtual hospital.” These models were then used to predict individual hospitals’ expected outcomes (both aggregate and, importantly, for risk-matched patient cohorts) for their own specific cases and case-mix, based on OCT analysis of aggregate data from the “virtual hospital.” Results: The raw average rates were HM = 4.4%, MVST = 15.3%, and LOS = 15.5%. Of 64 participating centers, in comparison with each hospital's specific case-adjusted benchmark, 17.0% statistically (under 90% confidence intervals) overperformed and 26.4% underperformed with respect to the predicted outcomes for their own specific cases and case-mix. For MVST and LOS, overperformers were 34.0% and 26.4%, and underperformers were 28.3% and 43.4%, respectively. OCT analyses reveal hospital-specific patient cohorts of either overperformance or underperformance. Conclusions: OCT benchmarking analysis can assess hospital-specific case-adjusted performance after CHS, both overall and patient cohort-specific, serving as a tool for hospital self-assessment and quality improvement.
MIT Department
Massachusetts Institute of Technology. Operations Research Center
Sloan School of Management
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DOI of Published Version
https://doi.org/10.1177/21501351211051227
