Measuring performance for end-of-life care

05/18/2021
by   Sebastien Haneuse, et al.
0

Although not without controversy, readmission is entrenched as a hospital quality metric, with statistical analyses generally based on fitting a logistic-Normal generalized linear mixed model. Such analyses, however, ignore death as a competing risk, although doing so for clinical conditions with high mortality can have profound effects; a hospitals seemingly good performance for readmission may be an artifact of it having poor performance for mortality. In this paper we propose novel multivariate hospital-level performance measures for readmission and mortality, that derive from framing the analysis as one of cluster-correlated semi-competing risks data. We also consider a number of profiling-related goals, including the identification of extreme performers and a bivariate classification of whether the hospital has higher-/lower-than-expected readmission and mortality rates, via a Bayesian decision-theoretic approach that characterizes hospitals on the basis of minimizing the posterior expected loss for an appropriate loss function. In some settings, particularly if the number of hospitals is large, the computational burden may be prohibitive. To resolve this, we propose a series of analysis strategies that will be useful in practice. Throughout the methods are illustrated with data from CMS on N=17,685 patients diagnosed with pancreatic cancer between 2000-2012 at one of J=264 hospitals in California.

READ FULL TEXT
POST COMMENT

Comments

There are no comments yet.

Authors

page 7

09/08/2020

Can we trust the standardized mortality ratio? A formal analysis and evaluation based on axiomatic requirements

Background: The standardized mortality ratio (SMR) is often used to asse...
09/13/2018

Causal Impact of the Hospital Readmissions Reduction Program on Hospital Readmissions and Mortality

Estimating causal effects of the Hospital Readmissions Reduction Program...
11/18/2020

Hidden chaos factors inducing random walks which reduce hospital operative efficiency

La Fuenfría Hospital (LFH) operative parameters such as: hospitalised pa...
01/26/2021

Applications of Clustering with Mixed Type Data in Life Insurance

Death benefits are generally the largest cash flow item that affects fin...
09/05/2020

Technological Platform for the Prevention and Management of Healthcare Associated Infections and Outbreaks

Hospital acquired infections are infections that occur in patients durin...
This week in AI

Get the week's most popular data science and artificial intelligence research sent straight to your inbox every Saturday.