Med Decis Making - Identifying individual changes in performance with composite quality indicators while accounting for regression to the mean.

Tópicos

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Resumo

Almost a decade ago Morton and Torgerson indicated that perceived medical benefits could be due to "regression to the mean." Despite this caution, the regression to the mean "effects on the identification of changes in institutional performance do not seem to have been considered previously in any depth" (Jones and Spiegelhalter). As a response, Jones and Spiegelhalter provide a methodology to adjust for regression to the mean when modeling recent changes in institutional performance for one-variable quality indicators. Therefore, in our view, Jones and Spiegelhalter provide a breakthrough methodology for performance measures. At the same time, in the interests of parsimony, it is useful to aggregate individual quality indicators into a composite score. Our question is, can we develop and demonstrate a methodology that extends the "regression to the mean" literature to allow for composite quality indicators? Using a latent variable modeling approach, we extend the methodology to the composite indicator case. We demonstrate the approach on 4 indicators collected by the National Database of Nursing Quality Indicators. A simulation study further demonstrates its "proof of concept."

Resumo Limpo

almost decad ago morton torgerson indic perceiv medic benefit due regress mean despit caution regress mean effect identif chang institut perform seem consid previous depth jone spiegelhalt respons jone spiegelhalt provid methodolog adjust regress mean model recent chang institut perform onevari qualiti indic therefor view jone spiegelhalt provid breakthrough methodolog perform measur time interest parsimoni use aggreg individu qualiti indic composit score question can develop demonstr methodolog extend regress mean literatur allow composit qualiti indic use latent variabl model approach extend methodolog composit indic case demonstr approach indic collect nation databas nurs qualiti indic simul studi demonstr proof concept

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