Time Series Monitors of Outcomes
A New Dimension for Measuring Quality of Care
Bibliographic Data
| ID | 9097683 |
|---|---|
| Authors | Guillermo Marshall (0000-0002-2902-014X, Pontificia Universidad Católica de Chile, corresponding author), A Laurie Shroyer (0000-0001-6461-0623), A Laurie W Shroyer, Fred L Grover, Fred Grover, Karl E Hammermeister |
| Year | 1998 |
| Volume | 36 |
| Issue | 3 |
| Pages | 348-356 |
| Publication date | 1998-03-01 |
| Open Access | No |
| Type | ARTICLE |
| Venue | Medical Care (JOURNAL) |
| Journal identifiers | ISSN: 0025-7079 • E-ISSN: 1537-1948 |
| Publisher | Ovid Technologies (Wolters Kluwer Health) (PUBLISHER) |
| DOI | 10.1097/00005650-199803000-00011 |
| PMID | 9520959 |
| OpenAlex | W2063104376 |
| Language | EN |
| Citations received | 2 |
| References cited | 27 |
OBJECTIVES: Despite the popularity of risk-adjusted outcomes as quality of health care indicators, their instability with time and their inability to provide reliable comparisons of small volume providers have raised questions about the feasibility and credibility of using these measures. In this article the authors describe a new analytic strategy to address these problems by examining risk-adjusted mortality with time, "Time Series Monitors of Outcome" (TSMO), and its application to cardiac surgery performed throughout the Department of Veterans Affairs between April 1987 and September 1992. METHODS: Expected operative mortality for 24,029 patients undergoing coronary artery bypass surgery at all 43 centers performing this procedure was estimated using a logistic regression model to adjust for patient-specific risk factors. The ratio of observed-to-expected operative mortality was calculated for each hospital for each of the 11 6-month periods. Poisson regression models were used to identify high and low outlier hospitals based on significant deviation from the 5.5 year overall mean and/or the individual hospital's trend of observed-to-expected ratios with time. RESULTS: This method identified four high and one low outlier hospitals based on significant deviations from the overall mean and three upward and seven downward trending outlier hospitals based on significant deviations in trend with time. A significant downward trend in observed-to-expected ratios of 4% per year also was observed for all coronary artery bypass graft procedures performed throughout the Department of Veterans Affairs during the last 5.5 year period. CONCLUSIONS: Time Series Monitors of Outcome should help reduce misclassification of outliers due to random variation in outcomes as well as provide more reliable comparative information from which to evaluate provider performance
Artery · Coronary artery bypass surgery · Logistic regression · Outlier · Poisson regression · Statistics · Veterans Affairs · Cardiac, Anesthesia and Surgical Outcomes · Emergency Medicine · Internal Medicine · Mathematics · Medicine · Patient Satisfaction in Healthcare · Sepsis Diagnosis and Treatment · Surgery
Hospital Characteristics and Mortality Rates
The meaning and use of the area under a receiver operating characteristic (ROC) curve.
Longitudinal data analysis using generalized linear models
Adjusted hospital death rates
Physician and Hospital Factors Associated With Mortality of Surgical Patients
An Index of Hospital Performance
Using Clinical Variables to Estimate the Risk of Patient Mortality
The Risk-Adjusted Mortality Index
The Measurement of Mortality
The Condition of the Literature on Differences in Hospital Mortality
| Citations per year | 0.07 |
|---|---|
| Citation span | 1998 - 2003 (6) |
| Highly cited | No |