Nuttall David, Parkin David, Devlin Nancy
Department of Health, London, UK.
Health Econ. 2015 Jan;24(1):41-54. doi: 10.1002/hec.2999. Epub 2013 Sep 30.
This paper describes the development of a methodology for the case-mix adjustment of patient-reported outcome measures (PROMs) data permitting the comparison of outcomes between providers on a like-for-like basis. Statistical models that take account of provider-specific effects form the basis of the proposed case-mix adjustment methodology. Indirect standardisation provides a transparent means of case mix adjusting the PROMs data, which are updated on a monthly basis. Recently published PROMs data for patients undergoing unilateral knee replacement are used to estimate empirical models and to demonstrate the application of the proposed case-mix adjustment methodology in practice. The results are illustrative and are used to highlight a number of theoretical and empirical issues that warrant further exploration. For example, because of differences between PROMs instruments, case-mix adjustment methodologies may require instrument-specific approaches. A number of key assumptions are made in estimating the empirical models, which could be open to challenge. The covariates of post-operative health status could be expanded, and alternative econometric methods could be employed.
本文描述了一种用于患者报告结局测量（PROMs）数据病例组合调整的方法的开发，该方法允许在同类基础上比较不同医疗服务提供者的结局。考虑医疗服务提供者特定效应的统计模型构成了所提出的病例组合调整方法的基础。间接标准化提供了一种对PROMs数据进行病例组合调整的透明方法，这些数据每月更新。最近公布的单侧膝关节置换患者的PROMs数据用于估计实证模型，并证明所提出的病例组合调整方法在实际中的应用。结果具有说明性，用于突出一些值得进一步探索的理论和实证问题。例如，由于PROMs工具之间的差异，病例组合调整方法可能需要特定于工具的方法。在估计实证模型时做出了一些关键假设，这些假设可能会受到挑战。术后健康状况的协变量可以扩展，并且可以采用替代的计量经济学方法。
