Department of Clinical Sciences, Social Epidemiology, Lund University, Malmö, Sweden.
Med Care. 2011 Mar;49(3):327-31. doi: 10.1097/MLR.0b013e31820325c5.
The use of league tables during the last decade has frequently been employed to assess quality in health care. However, few studies have attempted to assess quality by quantifying the variability across the organizational units or attempted to investigate whether the units are the correct context that really influences the outcome under study.
To quantify the variation between different organizational units regarding 5 different Swedish national pharmacological performance indicators and to examine whether the organizational units under study are a valid construct of the context that influences the specific outcome.
A multilevel model with patients nested within health care units that in turn were nested within County councils was used. By using measures of variance (intraclass correlation [ICC]), we quantified the extent to which the 5 indicators of health care quality were conditioned by the specified units.
For all 5 studied indicators, the variation between county councils was small (ICC ranged from 2% to 7%), whereas the variation among health care units seemed to be more important (ICC ranged from 20% to 40%).
As the variation between county councils was small, using league tables for performance evaluation seems to be inappropriate. If league tables are to be presented, the relative size of the variation at the higher levels and an analysis regarding the possible influence of the context for the specific outcome should be included. This approach provides useful information for identifying relevant contexts to capture health care variation.
在过去十年中，经常使用排行榜来评估医疗保健质量。然而，很少有研究试图通过量化组织单位之间的差异来评估质量，也很少有研究试图调查这些单位是否是真正影响所研究结果的正确环境。
量化 5 个不同的瑞典国家药理学绩效指标在不同组织单位之间的差异，并研究所研究的单位是否是影响特定结果的环境的有效结构。
使用多水平模型，将患者嵌套在医疗保健单位中，而医疗保健单位又嵌套在郡议会中。通过使用方差度量（组内相关系数 [ICC]），我们量化了医疗保健质量的 5 个指标受指定单位影响的程度。
对于所有 5 个研究指标，郡议会之间的差异较小（ICC 范围从 2%到 7%），而医疗保健单位之间的差异似乎更为重要（ICC 范围从 20%到 40%）。
由于郡议会之间的差异较小，使用排行榜进行绩效评估似乎不合适。如果要呈现排行榜，应包括较高层次的差异相对大小以及对特定结果的环境可能影响的分析。这种方法提供了有用的信息，可用于确定捕获医疗保健差异的相关环境。
