Regressions to Monitor Health Care Quality: A User’s Guide and a New Index

Authors

  • Richard J. Butler Brigham Young University, Arizona State University, USA
  • William G. Johnson Economics Department, Brigham Young University, Department of Bioinformatics, Arizona State University, USA

DOI:

https://doi.org/10.6000/1929-6029.2012.01.02.03

Keywords:

Health care quality, regression, hospital, exchange index

Abstract

: While there is a rich literature regarding hospital quality in general, research examining trends in hospital quality using regression analysis of trends are relatively rare. In the presence of the increasing digitalization of hospital data, the wide accessibility of regression software, and the need for real time feedback on ongoing quality of medical care outcomes, this paper presents simple-to-implement techniques for analyzing the quality of health care outcomes. We present graphical illustrations of the techniques discussed, and we also include a SAS appendix with the code to estimate all the models discussed, including a proposed new regression index: the Exchange index. We employ data from Arizona’s acute care hospitals to illustrate uses of our new index.

Author Biographies

Richard J. Butler, Brigham Young University, Arizona State University, USA

Economics Department, Department of Bioinformatics

William G. Johnson, Economics Department, Brigham Young University, Department of Bioinformatics, Arizona State University, USA

Economics Department, Department of Bioinformatics

References

Williams SC, Schmaltz SP, Morton DJ, Koss RG, Loeb JM. Quality of care in U.S. hospitals as reflected by standardized measures. N Engl J Med 2005; 353: 255-64. http://dx.doi.org/10.1056/NEJMsa043778 DOI: https://doi.org/10.1056/NEJMsa043778

Keeler EB, Rubenstein LV, Kahn KL, et al. Hospital characteristics and quality of care. JAMA 1992; 268(13): 1709-14. http://dx.doi.org/10.1001/jama.1992.03490130097037 DOI: https://doi.org/10.1001/jama.268.13.1709

Lindenauer PK, Remus D, Roman S, et al. Public reporting and pay for performance in hospital quality improvement. N Engl J Med 2007; 356: 486-96. http://dx.doi.org/10.1056/NEJMsa064964 DOI: https://doi.org/10.1056/NEJMsa064964

Jha AK, Li Z, Orav EJ, Epstein AM. Care in U.S. hospitals – the hospital quality alliance program. N Engl J Med 2005; 353: 265-74. http://dx.doi.org/10.1056/NEJMsa051249 DOI: https://doi.org/10.1056/NEJMsa051249

DesHarnais S, McMahon Jr. LF, Wroblewski R. Measuring outcomes of hospital care using multiple risk-adjusted indexes. Health Serv Res 1991; 26(4): 425-45.

Pauly MV, Brailer DJ, Kroch G, Even-Shoshan O. Measuring hospital outcomes from a buyer's perspective. Am J Med Quality 1996; 11(3): 112-22. http://dx.doi.org/10.1177/0885713X9601100302 DOI: https://doi.org/10.1177/0885713X9601100302

Dimick JB, Welch HG, Birkmeyer JD. Surgical mortality as an indicator of hospital quality – the problem with small sample size. JAMA 2004; 292(7): 847-51. http://dx.doi.org/10.1001/jama.292.7.847 DOI: https://doi.org/10.1001/jama.292.7.847

Butler RJ, McDonald JB. Measuring inequality with incomplete moments. J Economet 1989; 109-120. http://dx.doi.org/10.1016/0304-4076(89)90079-1 DOI: https://doi.org/10.1016/0304-4076(89)90079-1

Butler RJ, Johnson W, Wilson B. A modified measure of health care disparities applied to birth weight disparities and subsequent mortality. Health Econom 2012; 21(2): 113-26. http://dx.doi.org/10.1002/hec.1699 DOI: https://doi.org/10.1002/hec.1699

2011 data for Arizona Acute Short Term Hospitals. American Hospital Directory; [updated 2012 Oct 28; cited 2012 Nov 6]: Available from: http://www.ahd.com/states/hospital_AZ.html

Sochalski J, Aiken LH. Accounting for variation in hospital outcomes: a cross-national study Health Affairs 1999; 18(3): 256-9. http://dx.doi.org/10.1377/hlthaff.18.3.256 DOI: https://doi.org/10.1377/hlthaff.18.3.256

Medicare Administration, Hospital Acquired Conditions. US government; [updated 2012 Oct 11; cited 2012 Nov 6]: Available from: https://data.medicare.gov/browse?tags=hospital+compare&page=2

Lang TA, Hodge M, Olson V, Romano PS, Kravitz RL. Nurse-patient ratios: a systematic review on the effects of nurse staffing on patient, nurse employee, and hospital outcomes. J Nursing Admin 2004; 34(7-8): 326-37. http://dx.doi.org/10.1097/00005110-200407000-00005 DOI: https://doi.org/10.1097/00005110-200407000-00005

Pope GD, Birkmeyer JD, Finlayson SRG. National trends in utilization and in hospital outcomes of bariatric surgery. J Gastro Surg 2002; 855-61. DOI: https://doi.org/10.1016/S1091-255X(02)00085-9

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Published

2012-12-20

How to Cite

Butler, R. J., & Johnson, W. G. (2012). Regressions to Monitor Health Care Quality: A User’s Guide and a New Index. International Journal of Statistics in Medical Research, 1(2), 99–112. https://doi.org/10.6000/1929-6029.2012.01.02.03

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Section

General Articles