Centre for Health Economics, University of York, York, UK.
PHMR, London, UK.
Med Decis Making. 2020 May;40(4):511-521. doi: 10.1177/0272989X20927705. Epub 2020 Jun 3.
The English National Health Service publishes hospital performance indicators based on average postoperative EQ-5D index scores after hip replacement surgery to inform prospective patients' choices of hospital. Unidimensional index scores are derived from multidimensional health-related quality-of-life data using preference weights estimated from a sample of the UK general population. This raises normative concerns if general population preferences differ from those of the patients who are to be informed. This study explores how the source of valuation affects hospital performance estimates. Four different value sets reflecting source of valuation (general population v. patients), valuation technique (visual analog scale [VAS] v. time tradeoff [TTO]), and experience with health states (currently experienced vs. experimentally estimated) were used to derive and compare performance estimates for 243 hospitals. Two value sets were newly estimated from EQ-5D-3L data on 122,921 hip replacement patients and 3381 members of the UK general public. Changes in hospital ranking (nationally) and performance outlier status (nationally; among patients' 5 closest hospitals) were compared across valuations. National rankings were stable under different valuations (rank correlations >0.92). Twenty-three (9.5%) hospitals changed outlier status when using patient VAS valuations instead of general population TTO valuations, the current approach. Outlier status also changed substantially at the local level. This was explained mostly by the valuation technique, not the source of valuations or experience with the health states. No patient TTO valuations were available. The effect of value set characteristics could be established only through indirect comparisons. Different value sets may lead to prospective patients choosing different hospitals. Normative concerns about the use of general population valuations are not supported by empirical evidence based on VAS valuations.
英国国家医疗服务体系根据髋关节置换手术后平均术后 EQ-5D 指数评分发布医院绩效指标，以告知潜在患者选择医院。一维指数评分是根据多维健康相关生活质量数据得出的，使用从英国普通人群样本中估计的偏好权重。如果普通人群的偏好与将要接受信息的患者不同，这就引发了规范性问题。本研究探讨了估值的来源如何影响医院绩效评估。 有四个不同的价值集反映了估值的来源（普通人群与患者）、估值技术（视觉模拟量表[VAS]与时间权衡[TTO]）和健康状况的经验（当前经历与实验估计），用于推导和比较 243 家医院的绩效评估。两个价值集是根据 122921 名髋关节置换患者和 3381 名英国普通公众的 EQ-5D-3L 数据新估计的。在不同的估值中比较了医院排名（全国）和绩效异常状态（全国；在患者最近的 5 家医院中）的变化。 在不同的估值下，全国排名保持稳定（排名相关性>0.92）。当使用患者 VAS 估值而不是普通人群 TTO 估值（当前方法）时，23 家（9.5%）医院的异常状态发生了变化。在地方一级，异常状态也发生了很大变化。这主要是由于估值技术，而不是估值的来源或对健康状况的经验。 没有患者 TTO 估值可用。只有通过间接比较才能确定价值集特征的影响。 不同的价值集可能导致潜在患者选择不同的医院。基于 VAS 估值的实证证据不支持使用普通人群估值的规范性问题。
