Statistical Approaches for Quantifying the Quality of Neurosurgical Care.
Statistical Approaches for Quantifying the Quality of Neurosurgical Care.
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DOI：
10.1016/j.wneu.2022.01.047
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发表时间：
2022-05
影响因子：
2
通讯作者：
Horvitz-Lennon, Marcela
中科院分区：
文献类型：
--
作者：
Normand, Sharon-Lise T.;Zelevinsky, Katya;Abing, Haley K.;Horvitz-Lennon, Marcela
Quantifying quality of health care can provide valuable information to patients, providers, and policymakers. The observational nature of measuring quality, however, complicates assessments. We describe a conceptual model for defining quality and its implications about the data collected, how to make inferences about quality, and the assumptions required to provide statistically valid estimates. Twenty-one binary or polytomous quality measures collected from 101,051 adult Medicaid beneficiaries aged 18 – 64 years with schizophrenia from five U.S. states illustrate methodology. A categorical principal components analysis establishes dimensionality of quality, and item response theory models characterize the relationship between each quality measure and a unidimensional quality construct. Latent regression models estimate racial/ethnic and geographic quality disparities. Over 90% of beneficiaries filled at least one antipsychotic prescription and 19% were hospitalized for schizophrenia during a 12-month observational period in our multi-state cohort with ~2/3 non-white beneficiaries. Four quality constructs emerged: inpatient, emergency room, pharmacological/ambulatory, and ambulatory-only. Using a 2-parameter logistic model, pharmacological/ambulatory care quality varied from −2.35 to 1.26 (higher = better quality). Black and Latinx beneficiaries had lower pharmacological/ambulatory quality compared to whites. Race/ethnicity modified the association of state and pharmacological/ambulatory care quality in latent regression modeling. Average quality [95% interval] ranged from −0.28 [−2.15, 1.04] for blacks in New Jersey to 0.46 [−0.89, 1.40] for whites in Michigan. By combining multiple quality measures using item response theory models, a composite measure can be estimated that has more statistical power to detect differences among subjects than the observed mean per subject.
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影响因子：
--
作者：
Busch, AB;Frank, RG;Lehman, AF
通讯作者：
Lehman, AF
影响因子：
3.8
作者：
Horvitz-Lennon, Marcela;Alegria, Margarita;Normand, Sharon-Use T.
通讯作者：
Normand, Sharon-Use T.
影响因子：
3.4
作者：
Horvitz-Lennon, Marcela;Volya, Rita;Normand, Sharon-Lise T.
通讯作者：
Normand, Sharon-Lise T.
DOI：
10.2307/2983325
发表时间：
1996-01-01
影响因子：
2
作者：
Goldstein, H;Spiegelhalter, DJ
通讯作者：
Spiegelhalter, DJ
影响因子：
3.4
作者：
Horvitz-Lennon, Marcela;Volya, Rita;Normand, Sharon-Lise T.
通讯作者：
Normand, Sharon-Lise T.