ESTIMATING HOSPITAL QUALITY OF CARE: ISSUES & APPLICATIONS. Sharon-Lise T. Normand Health Care Policy, Harvard Medical School & Biostatistics, Harvard School of Public Health Quantify and compare the attributes of health care delivery and subsequent outcomes of health care. Acknowledgements.
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Sharon-Lise T. Normand
Health Care Policy, Harvard Medical School & Biostatistics, Harvard School of Public Health
Quantify and compare the attributes of health care delivery and subsequent outcomes of health care
December 12, 2006 NY Times: “Medicare links doctors’ pay to practices”
“After years of trying to rein in the runaway cost of the Medicare program, Congress has decided to use a carrot instead of a stick to change doctors’ behavior.
November 21, 2007: CMS proposes to implement a Medicare hospital value-based program based on:
~ Prior and ~ Prior (a-priori independent)
Problem: Almost always true that 2 > 0. How large is meaningful?
Solution: Don’t test; rather estimate.
Interpretation: Odds of dying in a high mortality hospital is seven times that of dying in a low mortality hospital.
E(-2 ) = 1
E( ) = 0.75
Range in odds from 1 to 358
Mode = 0 (no differences); Median = 0.39 (range in odds 4.6)
E( ) = 0.21
Complete Exchangeability: random effects arise from a normal model.
Posterior Estimates Under Complete Exchangeability Assumption, 0i ~ N(,2)
StandardizedMortality Incidence Rate (SMIR)
Predictive Cross-Validation Under Complete Exchangeability: number dying
Why such a large interval estimate (Hospital 13) with Surgery, Massachusetts (2002).419 Isolated CABG admissions?
Based on 2002 MA data:
IN Surgery, Massachusetts (2002).2003 CROSS-VALIDATED P-VALUES:
(predicted = 2.05% versus observed = 4.31%)
2002+2003 Combined Data:
Risk as measured by estimated Propensity Score Surgery, Massachusetts (2002).
Shahian and Normand, Circulation (2008)
Hospital Quality for CHF, 2004 (USA). 3271 hospitals. Surgery, Massachusetts (2002).
Hospital Quality: Raw sum scores versus Surgery, Massachusetts (2002).latent scores, 2004 (USA).
Model Checking: posterior predictive p-values. Surgery, Massachusetts (2002).
Teixeira-Pinto and Normand, Statistics in Medicine (2008)