Accounting for total variation and robustness in profiling health care providers.

Biostatistics
Lu XiaJohn Kalbfleisch

Abstract

Monitoring outcomes of health care providers, such as patient deaths, hospitalizations, and hospital readmissions, helps in assessing the quality of health care. We consider a large database on patients being treated at dialysis facilities in the United States, and the problem of identifying facilities with outcomes that are better than or worse than expected. Analyses of such data have been commonly based on random or fixed facility effects, which have shortcomings that can lead to unfair assessments. A primary issue is that they do not appropriately account for variation between providers that is outside the providers' control due, for example, to unobserved patient characteristics that vary between providers. In this article, we propose a smoothed empirical null approach that accounts for the total variation and adapts to different provider sizes. The linear model provides an illustration that extends easily to other non-linear models for survival or binary outcomes, for example. The empirical null method is generalized to allow for some variation being due to quality of care. These methods are examined with numerical simulations and applied to the monitoring of survival in the dialysis facility data.

References

Feb 11, 2014·Clinical Journal of the American Society of Nephrology : CJASN·Jay B Wish
Mar 7, 2017·Circulation. Cardiovascular Quality and Outcomes·Jacob V SpertusSherri Rose
Oct 20, 2018·Statistics in Medicine·Kevin HeZhe Fei

❮ Previous
Next ❯

Citations

Oct 24, 2019·Biometrics·Kevin HeJohn D Kalbfleisch
May 2, 2021·Anaesthesia·J Olivarius-McAllisterJ J Pandit

❮ Previous
Next ❯

Related Concepts

Trending Feeds

COVID-19

Coronaviruses encompass a large family of viruses that cause the common cold as well as more serious diseases, such as the ongoing outbreak of coronavirus disease 2019 (COVID-19; formally known as 2019-nCoV). Coronaviruses can spread from animals to humans; symptoms include fever, cough, shortness of breath, and breathing difficulties; in more severe cases, infection can lead to death. This feed covers recent research on COVID-19.

Blastomycosis

Blastomycosis fungal infections spread through inhaling Blastomyces dermatitidis spores. Discover the latest research on blastomycosis fungal infections here.

Nuclear Pore Complex in ALS/FTD

Alterations in nucleocytoplasmic transport, controlled by the nuclear pore complex, may be involved in the pathomechanism underlying multiple neurodegenerative diseases including Amyotrophic Lateral Sclerosis and Frontotemporal Dementia. Here is the latest research on the nuclear pore complex in ALS and FTD.

Applications of Molecular Barcoding

The concept of molecular barcoding is that each original DNA or RNA molecule is attached to a unique sequence barcode. Sequence reads having different barcodes represent different original molecules, while sequence reads having the same barcode are results of PCR duplication from one original molecule. Discover the latest research on molecular barcoding here.

Chronic Fatigue Syndrome

Chronic fatigue syndrome is a disease characterized by unexplained disabling fatigue; the pathology of which is incompletely understood. Discover the latest research on chronic fatigue syndrome here.

Evolution of Pluripotency

Pluripotency refers to the ability of a cell to develop into three primary germ cell layers of the embryo. This feed focuses on the mechanisms that underlie the evolution of pluripotency. Here is the latest research.

Position Effect Variegation

Position Effect Variagation occurs when a gene is inactivated due to its positioning near heterochromatic regions within a chromosome. Discover the latest research on Position Effect Variagation here.

STING Receptor Agonists

Stimulator of IFN genes (STING) are a group of transmembrane proteins that are involved in the induction of type I interferon that is important in the innate immune response. The stimulation of STING has been an active area of research in the treatment of cancer and infectious diseases. Here is the latest research on STING receptor agonists.

Microbicide

Microbicides are products that can be applied to vaginal or rectal mucosal surfaces with the goal of preventing, or at least significantly reducing, the transmission of sexually transmitted infections. Here is the latest research on microbicides.

Related Papers

Journal for Healthcare Quality : Official Publication of the National Association for Healthcare Quality
Amber PaulusLeroy Thacker
Joint Commission Journal on Quality and Patient Safety
Meredith Campbell BrittonSarwat I Chaudhry
© 2022 Meta ULC. All rights reserved