This software can be used to apply the PRAiS risk model for death within 30 days following cardiac surgery in children using routinely collected audit data and produce a Variable Life Adjusted Display (VLAD) chart to facilitate routine monitoring of programme-level outcomes.
We have updated the original PRAiS software to version 2.0. Main changes include:
The Excel file “Monitoring Outcomes with PRAiS v2.0.xls” is designed to allow UK paediatric cardiac centres to routinely monitor their short term surgical outcomes using the data that they collect for the Central Cardiac Audit Database (CCAD). Outcomes are partially risk adjusted using a model that estimates the risk of death within 30 days of a surgical procedure based on specific procedure, age, weight and a patient's recorded diagnoses and co-morbidities.
Outcomes over time are displayed using a bespoke version of the Variable Life Adjusted Display (VLAD) technique which is intended to facilitate the monitoring of clinical outcomes. The VLAD chart is a plot of the difference between the expected and actual tally of deaths. The plotted trace will rise for each survival and fall for each death, the height of the fall or rise depending on the estimated probability of death for that episode. The survival of a high risk episode results in a larger rise than the survival of a low risk episode and a death of a low risk episode results in a larger fall than a death of a high risk episode. In this way, the VLAD chart can help to identify runs of outcomes that are better or worse than expected, based on partial risk adjustment. If the VLAD plot goes down over time, there have been more deaths than expected and if it climbs, there have been more survivors than expected. If it fluctuates around the horizontal, then outcomes are broadly in line with expectations. We additionally highlight episodes where there was a reintervention within 30 days as part of the VLAD chart.
Example of a VLAD chart. This hypothetical unit had a run of survivors in early 2011 followed by a run of deaths in the spring of 2011. There were also clusters of reinterventions in the summer and autumn. Note that this is an illustrative example and does NOT correspond to actual data.
Users can enter data directly into the software in the format it is submitted to the National Institute of Cardiovascular Outcomes (NICOR) Central Cardiac Audit Database (CCAD). All pre-processing is performed as part of the software, including basic error and consistency checking.
After data are pre-processed, an estimated risk of death within 30 days following surgery is calculated for each surgical episode and a VLAD chart generated over the time period of the included data. To facilitate discussion of any deaths during the period, information on these patients is copied to a separate worksheet.
The software includes additional, optional, functionality for units to examine their recent case mix by bands of estimated risk of death and by mix of patients with different clinical features, along with a comparison to historical national data for interest. The software also includes a function to generate prediction limits for observed 30-day survival among surgical episodes.
Generating new VLADs is very easy – simply put the new data in the relevant worksheet and the software will reset all the other sheets as necessary when rerunning the model.
Further information can be found on the UCL research group's webpage at: http://www.ucl.ac.uk/operational-research/AnalysisTools/PRAiS
Users need to have Microsoft Excel for Microsoft Windows.
The software exists in two versions: Excel 2010 for Windows and Excel 2003 for Windows. It has only been tested in Windows 7 (Excel 2010) and Windows XP (Excel 2003) so we cannot guarantee it will work smoothly on other windows operating systems. Macros need to be enabled for the software to run.
The software does NOT work on Excel for Apple Macintosh.
PLEASE NOTE that the software was developed assuming that data corresponding to UK national audit is available. Required data are:
|Monitoring Outcomes with PRAiS Excel 2003 v2_1.xls||4.06 MB||2.1|
|Monitoring Outcomes with PRAiS Excel 2010 v2_1.xlsm||1.52 MB||2.1|
|Monitoring Outcomes with PRAiS User Instructions v2_0.pdf||1.37 MB||2.0|
|PRAiS changes to version 2.pdf||23.99 KB||2.0|
|Instructions comorbidity separation CCADExport.pdf||1.42 MB||2.0|
|Model Specification PRAiS v2_0.pdf||47.75 KB||2.0||
|Important Mappings Used For PRAiS v2_0.xlsx||95.52 KB||2.0||
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