Comparing healthcare quality: A common framework for both ordinal and cardinal data with an application to primary care variation in England

Paul Allanson (Lead / Corresponding author), Richard Cookson

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    Abstract

    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.
    Original languageEnglish
    Pages (from-to)2593-2608
    Number of pages16
    JournalHealth Economics
    Volume31
    Issue number12
    Early online date28 Aug 2022
    DOIs
    Publication statusPublished - Dec 2022

    Keywords

    • comparative quality evaluation
    • England
    • healthcare variation
    • ordinal data
    • primary care services

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