Survivors don't give a shit about quality of care, they want to know about quality of results. Will you fuckers do the proper research?
Oops, I'm not playing by the polite rules of Dale Carnegie, 'How to Win Friends and Influence People'.
Telling stroke medical persons they know nothing about stroke is a no-no even if it is true.
Politeness will never solve anything in stroke. Yes, I'm a bomb thrower and proud of it. Someday a stroke 'leader' will try to ream me out for making them look bad by being truthful , I look forward to that day.
Quality-of-care comparison of stroke: The reliability and robustness of ranking by process or outcome measuresJingkun Lihttps://orcid.org/0000-0001-8731-28721, Peng Qu2, Chao Wanghttps://orcid.org/0000-0003-0523-436X1, Xi Li1, Shuang Hou1, and Meina Liuhttps://orcid.org/0000-0002-3790-80691
Background and aimDiscussion on the most rational types of performance measures for care quality comparisons has received increasing attention. The important consideration is to what extent will the measure detect a genuine difference in the underlying quality. In this study, we aimed to compare the ranking of hospitals on the performance of individual indicators, composite scores (CS, that were calculated by the method of opportunity-based score on patient-level), and in-hospital outcome of acute ischemic stroke across hospitals, and determined the reliability and robustness of the three types of ranking.
MethodsWe analyzed data from 15,090 patients diagnosed with acute ischemic stroke who were treated at 184 large tertiary hospitals from January 2014 to May 2017. We ranked the hospital effects of recombinant tissue plasminogen activator (rt-PA) and CS and independence (modified Rankin Scale ≤2) at discharge based on fixed- and random-effects regression models before and after case-mix adjustment. We assessed the time-robustness of the hospital effects and calculated the rankability by relating the uncertainty within the hospital and the total hospital variation “beyond chance.”
ResultsAfter case-mix and reliability adjustment, we estimated that 84.03% of the variance in CS between hospitals was due to true quality differences. The uncertainty within hospitals caused a poor (49.51%) rankability in rt-PA and moderate rankability (63.34%) in independence at discharge. The hospital rankings of CS were more robust across years compared with rt-PA and independence.
ConclusionsOur data indicated that CS is the optimal measure to indicate the quality-of-care variation of acute ischemic stroke between hospitals.
Keywords
Quality of care, quality comparisons, ranking, rankability
1Department of Biostatistics, School of Public Health, Harbin Medical University, Harbin, China
2Department of Neurology, Daqing People's Hospital, Daqing, China
Corresponding author(s):
Meina Liu, Department of Biostatistics, School of Public Health, Harbin Medical University, No. 157 Baojian Road, Harbin, Heilongjiang Province 150081, China. Email: liumeina369@163.com
Background
In recent years, increasing attention has been paid to the effectiveness of performance measurement in healthcare. Specifically, quality comparisons between healthcare providers, such as ranking lists of hospitals or outlier status,1 are currently very popular, especially in the popular press and the internet. Such lists, however, have attracted resistance, criticism, and even anxiety among healthcare agencies.2,3 Publication of the comparison results will help address the issue of public reward and accountability, but at the same time may engender negative behaviors such as high-risk case avoidance and “gaming” of the reporting system, especially in those hospitals with poor rankings. With these potential consequences, quality-of-care comparisons should be scrupulous.4
Donabedian has suggested that quality of care is a function of three components (structure, process, and outcome).5 Despite this suggestion, outcome indicators are by far the most common measures in quality comparisons because of the serious and unambiguous nature;3,6 however, many studies have questioned the validity of such comparison results.7 Some researchers have attempted to measure the underlying concept of quality care by individual or composite process indicators.8,9 The discussion regarding the most rational types of performance measures for monitoring healthcare quality has always been an international concern.10,11 Numerous factors are potentially responsible for the variation in quality measurement, such as case-mix, chance variation, data source. The most important consideration is to what extent will the indicator detect a genuine difference in the underlying quality.12
In 2009, the National Health Commission of the People’s Republic of China launched a quality improvement program and built the National Specific (Single) Disease Monitoring System, which aimed to monitor and improve the quality of healthcare for specific diseases.13,14 The main focus was on the process of care and in-hospital outcomes. Current studies may fail to provide adequate information to patients, clinicians, and policymakers seeking to identify hospitals that provide high-quality acute ischemic stroke (AIS) care. Thus, we aimed to compare the ranking of hospitals on the performance of individual indicators, composite scores (CS), in-hospital outcome of AIS across hospitals, and determined the reliability and robustness of the three types of ranking.
Background and aim
MethodsWe analyzed data from 15,090 patients diagnosed with acute ischemic stroke who were treated at 184 large tertiary hospitals from January 2014 to May 2017. We ranked the hospital effects of recombinant tissue plasminogen activator (rt-PA) and CS and independence (modified Rankin Scale ≤2) at discharge based on fixed- and random-effects regression models before and after case-mix adjustment. We assessed the time-robustness of the hospital effects and calculated the rankability by relating the uncertainty within the hospital and the total hospital variation “beyond chance.”
ResultsAfter case-mix and reliability adjustment, we estimated that 84.03% of the variance in CS between hospitals was due to true quality differences. The uncertainty within hospitals caused a poor (49.51%) rankability in rt-PA and moderate rankability (63.34%) in independence at discharge. The hospital rankings of CS were more robust across years compared with rt-PA and independence.
ConclusionsOur data indicated that CS is the optimal measure to indicate the quality-of-care variation of acute ischemic stroke between hospitals.
Keywords
Quality of care, quality comparisons, ranking, rankability
1Department of Biostatistics, School of Public Health, Harbin Medical University, Harbin, China
2Department of Neurology, Daqing People's Hospital, Daqing, China
Corresponding author(s):
Meina Liu, Department of Biostatistics, School of Public Health, Harbin Medical University, No. 157 Baojian Road, Harbin, Heilongjiang Province 150081, China. Email: liumeina369@163.com
Background
In recent years, increasing attention has been paid to the effectiveness of performance measurement in healthcare. Specifically, quality comparisons between healthcare providers, such as ranking lists of hospitals or outlier status,1 are currently very popular, especially in the popular press and the internet. Such lists, however, have attracted resistance, criticism, and even anxiety among healthcare agencies.2,3 Publication of the comparison results will help address the issue of public reward and accountability, but at the same time may engender negative behaviors such as high-risk case avoidance and “gaming” of the reporting system, especially in those hospitals with poor rankings. With these potential consequences, quality-of-care comparisons should be scrupulous.4
Donabedian has suggested that quality of care is a function of three components (structure, process, and outcome).5 Despite this suggestion, outcome indicators are by far the most common measures in quality comparisons because of the serious and unambiguous nature;3,6 however, many studies have questioned the validity of such comparison results.7 Some researchers have attempted to measure the underlying concept of quality care by individual or composite process indicators.8,9 The discussion regarding the most rational types of performance measures for monitoring healthcare quality has always been an international concern.10,11 Numerous factors are potentially responsible for the variation in quality measurement, such as case-mix, chance variation, data source. The most important consideration is to what extent will the indicator detect a genuine difference in the underlying quality.12
In 2009, the National Health Commission of the People’s Republic of China launched a quality improvement program and built the National Specific (Single) Disease Monitoring System, which aimed to monitor and improve the quality of healthcare for specific diseases.13,14 The main focus was on the process of care and in-hospital outcomes. Current studies may fail to provide adequate information to patients, clinicians, and policymakers seeking to identify hospitals that provide high-quality acute ischemic stroke (AIS) care. Thus, we aimed to compare the ranking of hospitals on the performance of individual indicators, composite scores (CS), in-hospital outcome of AIS across hospitals, and determined the reliability and robustness of the three types of ranking.
No comments:
Post a Comment