TY - JOUR
T1 - Comparing healthcare quality
T2 - A common framework for both ordinal and cardinal data with an application to primary care variation in England
AU - Allanson, Paul
AU - Cookson, Richard
N1 - Funding Information:
The authors bear sole responsibility for the further analysis and interpretation of NHS GP Patient Survey, CQC Care Directory and NHS Quality and Outcomes Framework data employed in this study. Cookson acknowledges the financial support of the Wellcome Trust (Grant No. 205427/Z/16/Z). The views expressed are those of the authors and not the Wellcome Trust.
Publisher Copyright:
© 2022 The Authors. Health Economics published by John Wiley & Sons Ltd.
PY - 2022/12
Y1 - 2022/12
N2 - 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.
AB - 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.
KW - comparative quality evaluation
KW - England
KW - healthcare variation
KW - ordinal data
KW - primary care services
UR - http://www.scopus.com/inward/record.url?scp=85136862858&partnerID=8YFLogxK
U2 - 10.1002/hec.4597
DO - 10.1002/hec.4597
M3 - Article
C2 - 36030529
SN - 1057-9230
VL - 31
SP - 2593
EP - 2608
JO - Health Economics
JF - Health Economics
IS - 12
ER -