Statistical insights for crude-rate-based operational measures of misdiagnosis-related harms.
Statistical insights for crude-rate-based operational measures of misdiagnosis-related harms.
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DOI：
10.1002/sim.9039
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发表时间：
2021-09-10
影响因子：
2
通讯作者：
Newman-Toker D
中科院分区：
文献类型：
--
作者：
Zhu Y;Wang Z;Liberman AL;Chang TP;Newman-Toker D
在纵向事件数据中，粗率是事件率的简单量化，定义为评估窗口期间的事件数量除以该窗口开始或中间时间点的高危人群规模。最近，这一粗率重新引起了医学研究人员的兴趣，他们的目标是通过跟踪“良性”诊断后的意外不良事件，使用管理或账单数据来改善误诊相关损害的测量。这些措施的简单性使它们对医院或卫生系统一级的实施和常规业务监测具有吸引力。然而，相关的统计推断程序还没有得到系统的总结。此外，尚不清楚高危人群规模的时间变化会在多大程度上偏向分析，并影响有关误诊相关危害的重要结论。在这篇文章中，我们介绍了使用基于原油利率的伤害度量的统计推断工具，以及量化此类度量与基于更复杂的Nelson-Aalen估计的偏差的公式和模拟结果。此外，我们还给出了广义多仓形式的粗率的结果，其中通常的粗率是单仓的特殊情况。广义多仓原油运转率比Nelson-Aalen估计器更容易计算，并且可以减少单库原油运转率的潜在偏差。对于寻求使用多箱测量的研究，我们提供模拟来指导关于箱的数量的选择。我们使用一个来自大型数据集的中风后“良性”头晕的工作例子进一步支持了这些结果。
In longitudinal event data, a crude rate is a simple quantification of the event rate, defined as the number of events during an evaluation window, divided by the at-risk population size at the beginning or mid-time point of that window. The crude rate recently received revitalizing interest from medical researchers who aimed to improve measurement of misdiagnosis-related harms using administrative or billing data by tracking unexpected adverse events following a “benign” diagnosis. The simplicity of these measures makes them attractive for implementation and routine operational monitoring at hospital or health system level. However, relevant statistical inference procedures have not been systematically summarized. Moreover, it is unclear to what extent the temporal changes of the at-risk population size would bias analyses and affect important conclusions concerning misdiagnosis-related harms. In this article, we present statistical inference tools for using crude-rate based harm measures, as well as formulas and simulation results that quantify the deviation of such measures from those based on the more sophisticated Nelson-Aalen estimator. Moreover, we present results for a generalized multibin version of the crude rate, for which the usual crude rate is a single-bin special case. The generalized multibin crude rate is more straightforward to compute than the Nelson-Aalen estimator and can reduce potential biases of the single-bin crude rate. For studies that seek to use multibin measures, we provide simulations to guide the choice regarding number of bins. We further bolster these results using a worked example of stroke after “benign” dizziness from a large data set.
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影响因子：
120.7
作者：
Hayward, RA;Hofer, TP
通讯作者：
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影响因子：
6.2
作者：
Kim, Anthony S.;Fullerton, Heather J.;Johnston, S. Claiborne
通讯作者：
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影响因子：
2.5
作者：
NELSON, W
通讯作者：
NELSON, W
DOI：
10.1198/016214502753479383
发表时间：
2002-03-01
影响因子：
3.7
作者：
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通讯作者：
Sasieni, P
影响因子：
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作者：
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