Dataset Information

Intraclass reliability for assessing how well Taiwan constrained hospital-provided medical services using statistical process control chart techniques.

ABSTRACT:

Background

Few studies discuss the indicators used to assess the effect on cost containment in healthcare across hospitals in a single-payer national healthcare system with constrained medical resources. We present the intraclass correlation coefficient (ICC) to assess how well Taiwan constrained hospital-provided medical services in such a system.

Methods

A custom Excel-VBA routine to record the distances of standard deviations (SDs) from the central line (the mean over the previous 12?months) of a control chart was used to construct and scale annual medical expenditures sequentially from 2000 to 2009 for 421 hospitals in Taiwan to generate the ICC. The ICC was then used to evaluate Taiwan's?year-based convergent power to remain unchanged in hospital-provided constrained medical services. A bubble chart of SDs for a specific month was generated to present the effects of using control charts in a national healthcare system.

Results

ICCs were generated for Taiwan's?year-based convergent power to constrain its medical services from 2000 to 2009. All hospital groups showed a gradually well-controlled supply of services that decreased from 0.772 to 0.415. The bubble chart identified outlier hospitals that required investigation of possible excessive reimbursements in a specific time period.

Conclusion

We recommend using the ICC to annually assess a nation's?year-based convergent power to constrain medical services across hospitals. Using sequential control charts to regularly monitor hospital reimbursements is required to achieve financial control in a single-payer nationwide healthcare system.

SUBMITTER: Chien TW

PROVIDER: S-EPMC3536588 | biostudies-literature | 2012 May

REPOSITORIES: biostudies-literature

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Publications

Intraclass reliability for assessing how well Taiwan constrained hospital-provided medical services using statistical process control chart techniques.

Chien Tsair-Wei TW Chou Ming-Ting MT Wang Wen-Chung WC Tsai Li-Shu LS Lin Weir-Sen WS

BMC medical research methodology 20120515

<h4>Background</h4>Few studies discuss the indicators used to assess the effect on cost containment in healthcare across hospitals in a single-payer national healthcare system with constrained medical resources. We present the intraclass correlation coefficient (ICC) to assess how well Taiwan constrained hospital-provided medical services in such a system.<h4>Methods</h4>A custom Excel-VBA routine to record the distances of standard deviations (SDs) from the central line (the mean over the previ ...[more]

PMID: 22587736

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Project description:PurposeFirst, to evaluate inter-rater reliability when human raters estimate the reading performance of visually impaired individuals using the MNREAD acuity chart. Second, to evaluate the agreement between computer-based scoring algorithms and compare them with human rating.MethodsReading performance was measured for 101 individuals with low vision, using the Portuguese version of the MNREAD test. Seven raters estimated the maximum reading speed (MRS) and critical print size (CPS) of each individual MNREAD curve. MRS and CPS were also calculated automatically for each curve using two different algorithms: the original standard deviation method (SDev) and a non-linear mixed effects (NLME) modeling. Intra-class correlation coefficients (ICC) were used to estimate absolute agreement between raters and/or algorithms.ResultsAbsolute agreement between raters was 'excellent' for MRS (ICC = 0.97; 95%CI [0.96, 0.98]) and 'moderate' to 'good' for CPS (ICC = 0.77; 95%CI [0.69, 0.83]). For CPS, inter-rater reliability was poorer among less experienced raters (ICC = 0.70; 95%CI [0.57, 0.80]) when compared to experienced ones (ICC = 0.82; 95%CI [0.76, 0.88]). Absolute agreement between the two algorithms was 'excellent' for MRS (ICC = 0.96; 95%CI [0.91, 0.98]). For CPS, the best possible agreement was found for CPS defined as the print size sustaining 80% of MRS (ICC = 0.77; 95%CI [0.68, 0.84]). Absolute agreement between raters and automated methods was 'excellent' for MRS (ICC = 0.96; 95% CI [0.88, 0.98] for SDev; ICC = 0.97; 95% CI [0.95, 0.98] for NLME). For CPS, absolute agreement between raters and SDev ranged from 'poor' to 'good' (ICC = 0.66; 95% CI [0.3, 0.80]), while agreement between raters and NLME was 'good' (ICC = 0.83; 95% CI [0.76, 0.88]).ConclusionFor MRS, inter-rater reliability is excellent, even considering the possibility of noisy and/or incomplete data collected in low-vision individuals. For CPS, inter-rater reliability is lower. This may be problematic, for instance in the context of multisite investigations or follow-up examinations. The NLME method showed better agreement with the raters than the SDev method for both reading parameters. Setting up consensual guidelines to deal with ambiguous curves may help improve reliability. While the exact definition of CPS should be chosen on a case-by-case basis depending on the clinician or researcher's motivations, evidence suggests that estimating CPS as the smallest print size sustaining about 80% of MRS would increase inter-rater reliability.

Dataset Information

Intraclass reliability for assessing how well Taiwan constrained hospital-provided medical services using statistical process control chart techniques.

Background

Methods

Results

Conclusion

Publications

Intraclass reliability for assessing how well Taiwan constrained hospital-provided medical services using statistical process control chart techniques.

Similar Datasets

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