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On the correlation between outcome indicators and the structure and process indicators used to proxy them in public health care reporting.

ABSTRACT: Hospital quality indicators provide valuable insights for quality improvement, empower patients to choose providers, and have become a cornerstone of value-based payment. As outcome indicators are cumbersome and expensive to measure, many health systems have relied on proxy indicators, such as structure and process indicators. In this paper, we assess the extent to which publicly reported structure and process indicators are correlated with outcome indicators, to determine if these provide useful signals to inform the public about the outcomes. Quality indicators for three conditions (breast and colorectal cancer, and hip replacement surgery) for Dutch hospitals (2011-2018) were collected. Structure and process indicators were compared to condition-specific outcome indicators and in-hospital mortality ratios in a between-hospital comparison (cross-sectional and between-effects models) and in within-hospital comparison (fixed-effects models). Systematic association could not be observed for any of the models. Both positive and negative signs were observed where negative associations were to be expected. Despite sufficient statistical power, the share of significant correlations was small [mean share: 13.2% (cross-sectional); 26.3% (between-effects); 13.2% (fixed-effects)]. These findings persisted in stratified analyses by type of hospital and in models using a multivariate approach. We conclude that, in the context of compulsory public reporting, structure and process indicators are not correlated with outcome indicators, neither in between-hospital comparisons nor in within-hospital comparisons. While structure and process indicators remain valuable for internal quality improvement, they are unsuitable as signals for informing the public about hospital differences in health outcomes.

SUBMITTER: Salampessy BH

PROVIDER: S-EPMC8526472 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundScientific research has provided evidence on benefits of well developed primary care systems. The relevance of some of this research for the European situation is limited.There is currently a lack of up to date comprehensive and comparable information on variation in development of primary care, and a lack of knowledge of structures and strategies conducive to strengthening primary care in Europe. The EC funded project Primary Health Care Activity Monitor for Europe (PHAMEU) aims to fill this gap by developing a Primary Care Monitoring System (PC Monitor) for application in 31 European countries. This article describes the development of the indicators of the PC Monitor, which will make it possible to create an alternative model for holistic analyses of primary care.MethodsA systematic review of the primary care literature published between 2003 and July 2008 was carried out. This resulted in an overview of: (1) the dimensions of primary care and their relevance to outcomes at (primary) health system level; (2) essential features per dimension; (3) applied indicators to measure the features of primary care dimensions. The indicators were evaluated by the project team against criteria of relevance, precision, flexibility, and discriminating power. The resulting indicator set was evaluated on its suitability for Europe-wide comparison of primary care systems by a panel of primary care experts from various European countries (representing a variety of primary care systems).ResultsThe developed PC Monitor approaches primary care in Europe as a multidimensional concept. It describes the key dimensions of primary care systems at three levels: structure, process, and outcome level. On structure level, it includes indicators for governance, economic conditions, and workforce development. On process level, indicators describe access, comprehensiveness, continuity, and coordination of primary care services. On outcome level, indicators reflect the quality, and efficiency of primary care.ConclusionsA standardized instrument for describing and comparing primary care systems has been developed based on scientific evidence and consensus among an international panel of experts, which will be tested to all configurations of primary care in Europe, intended for producing comparable information. Widespread use of the instrument has the potential to improve the understanding of primary care delivery in different national contexts and thus to create opportunities for better decision making.

Project description:Reporting the results of quality indicators can narrow the gap in the quality of care between hospitals. While most studies rely on outcome indicators, they may not accurately measure the quality of care. Process indicators are not only strongly associated with treatment outcomes, but are also more sensitive to whether patients are treated accurately, enabling timely intervention. Our study aims to investigate whether process indicators provide a more reasonable assessment of hospital quality of care compared to outcome indicators. Data were sourced from the Specific Disease Medical Service Quality Management and Control System in China. A total of 113,942 patients with breast cancer treated in 298 hospitals between January 2019 and April 2023 were included in this retrospective study. The rankability of 11 process indicators was calculated and used as a weight to create a new composite indicator. The composite indicators and outcome measures were compared using the O/E ratio categories. Finally, in order to determine the impact of different years on the results, a sensitivity analysis was conducted using bootstrap sampling. The rankability ( ρ ) values of the eleven process indicators showed significant differences, with the highest ρ value for preoperative cytological or histological examination before surgery (0.919). The ρ value for the outcome indicator was 0.011. The rankability-weighting method yielded a comprehensive score ( ρ = 0.883). The comparison with categorical results of the outcome indicator has different performance classifications for 113 hospitals (37.92%) for composite scores and 140 (46.98%) for preoperative cytological or histological examinationbefore surgery. Process indicators are more suitable than outcome indicators for assessing the quality of breast cancer care in hospitals. Healthcare providers can use process indicators to identify specific areas for improvement, thereby driving continuous quality improvement efforts.

Project description:BackgroundQuality of care public reporting provides structural, process and outcome information to facilitate hospital choice and strengthen quality competition. Yet, evidence indicates that patients rarely use this information in their decision-making, due to limited awareness of the data and complex and conflicting information. While there is enthusiasm among policy makers for public reporting, clinicians and researchers doubt its overall impact. Almost no study has analyzed how users behave on public reporting portals, which information they seek out and when they abort their search.MethodsThis study employs web-usage mining techniques on server log data of 17 million user actions from Germany's premier provider transparency portal Weisse-Liste.de (WL.de) between 2012 and 2015. Postal code and ICD search requests facilitate identification of geographical and treatment area usage patterns. User clustering helps to identify user types based on parameters like session length, referrer and page topic visited. First-level markov chains illustrate common click paths and premature exits.ResultsIn 2015, the WL.de Hospital Search portal had 2,750 daily users, with 25% mobile traffic, a bounce rate of 38% and 48% of users examining hospital quality information. From 2013 to 2015, user traffic grew at 38% annually. On average users spent 7 min on the portal, with 7.4 clicks and 54 s between clicks. Users request information for many oncologic and orthopedic conditions, for which no process or outcome quality indicators are available. Ten distinct user types, with particular usage patterns and interests, are identified. In particular, the different types of professional and non-professional users need to be addressed differently to avoid high premature exit rates at several key steps in the information search and view process. Of all users, 37% enter hospital information correctly upon entry, while 47% require support in their hospital search.ConclusionsSeveral onsite and offsite improvement options are identified. Public reporting needs to be directed at the interests of its users, with more outcome quality information for oncology and orthopedics. Customized reporting can cater to the different needs and skill levels of professional and non-professional users. Search engine optimization and hospital quality advocacy can increase website traffic.

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On the correlation between outcome indicators and the structure and process indicators used to proxy them in public health care reporting.

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