Department of Health Care Policy, Harvard Medical School, Boston, MA, 02115, USA.
Stat Med. 2018 May 30;37(12):2053-2066. doi: 10.1002/sim.7656. Epub 2018 Apr 2.
Public quality reports for Medicare Advantage health plans include 11 measures of patient experiences reported in the annual Consumer Assessment of Healthcare Providers and Systems surveys. Computing summaries at the health plan level (of multiple measures in multiple years) yields an array-structured random variable. To summarize associations among measures and years, we model the variance-covariance matrix governing the plan-level vectors of yearly quality measures as a Kronecker product of an across-measure matrix and an across-year matrix, or a sum of such Kronecker products. This approach extends separable covariance structure to Fay-Herriot models. In addition, we develop linear combinations of Kronecker products similar to principal components for array random variables. To each Kronecker-product term, we apply post hoc analyses suited to the corresponding dimension of the cross-classification: 1-way factor analysis for the across-measure factor and time-series analysis to the across-year factor. These methods draw out key patterns of variation in the quality measures over time and suggest new strategies for reporting quality information to consumers.
医疗保险优势健康计划的公共质量报告包括 11 项患者体验指标，这些指标是在年度医疗保健提供者和系统消费者评估调查中报告的。在健康计划层面（多年多项措施）计算摘要会产生一个数组结构的随机变量。为了总结措施和年份之间的关联，我们将管理计划层面年度质量措施向量的方差协方差矩阵建模为跨措施矩阵和跨年份矩阵的 Kronecker 积，或此类 Kronecker 积的总和。这种方法将可分离协方差结构扩展到 Fay-Herriot 模型。此外，我们还为数组随机变量开发了类似于主成分的 Kronecker 积线性组合。对于每个 Kronecker 积项，我们应用适合交叉分类相应维度的事后分析：跨措施因子的 1 路因子分析和跨年份因子的时间序列分析。这些方法揭示了质量措施随时间变化的关键模式，并为向消费者报告质量信息提出了新的策略。
