RAND Corporation, Santa Monica, California, USA.
Kaiser Permanente Research, Pasadena, California, USA.
BMJ Qual Saf. 2015 Feb;24(2):128-34. doi: 10.1136/bmjqs-2014-003405. Epub 2014 Nov 13.
Public report card designers aim to provide comprehensible provider performance information to consumers. Report cards often display classifications of providers into performance tiers that reflect whether performance is statistically significantly above or below average or not statistically significantly different from average. To further enhance the salience of public reporting to consumers, report card websites often allow a user to compare a subset of selected providers on tiered performance rather than direct statistical comparisons of the providers in a consumer's personal choice set.
We illustrate the differences in conclusions drawn about relative provider performance using tiers versus conducing statistical tests to assess performance differences.
Using publicly available cross-sectional data from Medicare Hospital Compare on three mortality and three readmission outcome measures, we compared each provider in the top or bottom performance tier with those in the middle tier and assessed the proportion of such comparisons that exhibited no statistically significant differences.
Across the six outcomes, 1.3-6.1% of hospitals were classified in the top tier. Each top-tier hospital did not statistically significantly differ in performance from at least one mid-tier hospital. The percentages of mid-tier hospitals that were not statistically significantly different from a given top-tier hospital were 74.3-81.1%. The percentages of hospitals classified as bottom tier were 0.6-4.0%. Each bottom-tier hospital showed no statistically significant difference from at least one mid-tier hospital. The percentage of mid-tier hospitals that were not significantly different from a bottom-tier hospital ranged from 60.4% to 74.8%.
Our analyses illustrate the need for further innovations in the design of public report cards to enhance their salience for consumers.
公共报告卡设计师旨在为消费者提供易于理解的供应商绩效信息。报告卡通常将供应商分类为绩效等级，反映绩效是否明显高于或低于平均水平，或者与平均水平无显著差异。为了进一步提高公共报告对消费者的显著性，报告卡网站通常允许用户比较选定供应商的分层绩效，而不是直接对消费者选择集中的供应商进行统计比较。
我们通过使用等级和进行统计测试来评估绩效差异，来说明关于相对供应商绩效的结论差异。
我们使用 Medicare Hospital Compare 上公开的横断面数据，对三个死亡率和三个再入院结果指标进行了比较，将每个处于最高或最低绩效等级的提供者与处于中间等级的提供者进行比较，并评估了这些比较中表现出无统计学显著差异的比例。
在六个结果中，有 1.3%-6.1%的医院被分类为顶级医院。每个顶级医院的表现与至少一个中层医院在统计学上没有显著差异。中层医院中与特定顶级医院无统计学显著差异的比例为 74.3%-81.1%。被归类为底层医院的比例为 0.6%-4.0%。每个底层医院与至少一个中层医院在统计学上没有显著差异。中层医院与底层医院无显著差异的比例范围从 60.4%到 74.8%。
我们的分析说明了公共报告卡设计需要进一步创新，以提高其对消费者的显著性。
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