UDSB, University of Dundee, Dundee, UK.
Centre for Health Economics, University of York, York, UK.
Health Econ. 2022 Dec;31(12):2593-2608. doi: 10.1002/hec.4597. Epub 2022 Aug 28.
The paper proposes a framework for comparing the quality of healthcare providers and assessing the variation in quality between them, which is directly applicable to both ordinal and cardinal quality data on a comparable basis. The resultant measures are sensitive to the full distribution of quality scores for each provider, not just the mean or the proportion meeting some binary quality threshold, thereby making full use of the multicategory response data increasingly available from patient experience surveys. The measures can also be standardized for factors such as age, sex, ethnicity, health and deprivation using a distribution regression model. We illustrate by measuring the quality of primary care services in England in 2019 using three different sources of publicly available, general practice-level information: multicategory response patient experience data, ordinal inspection ratings and cardinal clinical achievement scores. We find considerable variation at both local and regional levels using all three data sources. However, the correlation between the comparative quality indices calculated using the alternative data sources is weak, suggesting that they capture different aspects of general practice quality.
本文提出了一个框架，用于比较医疗服务提供者的质量，并评估它们之间的质量差异，该框架可以直接应用于基于可比基础的序数和基数质量数据。由此产生的衡量标准对每个提供者的质量评分的全部分布敏感，而不仅仅是平均值或符合某些二元质量阈值的比例，从而充分利用了越来越多的来自患者体验调查的多类别响应数据。这些措施还可以使用分布回归模型针对年龄、性别、种族、健康状况和贫困等因素进行标准化。我们通过使用三种不同的公开可得的、一般实践层面的信息来源来衡量 2019 年英格兰初级保健服务的质量来说明：多类别响应患者体验数据、有序检查评级和基数临床绩效评分。我们发现，使用所有三种数据源，在地方和区域层面都存在相当大的差异。然而，使用替代数据源计算的比较质量指数之间的相关性较弱，表明它们捕捉到了一般实践质量的不同方面。
