Risk adjustment of health-care performance measures in a multinational register-based study: A pragmatic approach to a complicated topic

SAGE Open Medicine
Tron Anders Moger, Mikko Peltola

Abstract

Health-care performance comparisons across countries are gaining popularity. In such comparisons, the risk adjustment methodology plays a key role for meaningful comparisons. However, comparisons may be complicated by the fact that not all participating countries are allowed to share their data across borders, meaning that only simple methods are easily used for the risk adjustment. In this study, we develop a pragmatic approach using patient-level register data from Finland, Hungary, Italy, Norway, and Sweden. Data on acute myocardial infarction patients were gathered from health-care registers in several countries. In addition to unadjusted estimates, we studied the effects of adjusting for age, gender, and a number of comorbidities. The stability of estimates for 90-day mortality and length of stay of the first hospital episode following diagnosis of acute myocardial infarction is studied graphically, using different choices of reference data. Logistic regression models are used for mortality, and negative binomial models are used for length of stay. Results from the sensitivity analysis show that the various models of risk adjustment give similar results for the countries, with some exceptions for Hungary and Italy. Based o...Continue Reading

References

Oct 16, 2007·Journal of Epidemiology and Community Health·Jon Nicholl
Jun 10, 2011·Annals of Medicine·Unto Häkkinen
Jul 16, 2011·Journal of Health Services Research & Policy·Niek KlazingaAugustinus ten Asbroek

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Citations

Jan 10, 2020·Scandinavian Journal of Public Health·Unto HäkkinenClas Rehnberg
Dec 4, 2015·Health Economics·Emma MedinUNKNOWN EuroHOPE study group
Dec 4, 2015·Health Economics·Richard HeijinkUNKNOWN EuroHOPE study group
Dec 4, 2015·Health Economics·Sverre A C KittelsenUNKNOWN EuroHOPE study group

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Software Mentioned

PERFormance
EuroHOPE

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