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Evaluating Risk-Adjusted Hospital Performance Using Large-Scale Data on Mortality Rates of Patients in Intensive Care Units: A Flexible Semi-Nonparametric Modeling Approach

Authors :
Yakun Liang
Xuejun Jiang
Bo Zhang
Source :
IEEE Journal of Translational Engineering in Health and Medicine, Vol 11, Pp 232-246 (2023)
Publication Year :
2023
Publisher :
IEEE, 2023.

Abstract

Background and objective: Significant variability in the quality of healthcare supplied by hospitals is drawing broad attention from the United States Centers for Medicare and Medicaid Services. The primary issue is to evaluate hospital performance based on patient outcomes. Generalized linear random-effects models are a promising analytical tool for evaluating hospital performance. However, hospital compare data often violate the classical assumptions of normality on random effects and linearity representation on transformed conditional mean structures in these models. Methods: In this article, we proposed and tested the performance of a class of hospital compare models that embraces nonparametric mean structures with semi-nonparametric hospital random effects. Such models were further improved and integrated into a zero-inflated model. $\mathtt {SAS}$ programs to implement these newly proposed hospital compare models were thoroughly developed. The $\mathtt {SAS}$ programs are freely available via a GitHub (https:\\www.GitHub.com) repository. Results: We demonstrate the robustness of the proposed hospital compare models by conducting intensive empirical studies. Flexible semi-nonparametric random effects and functional fixed-effects mean structure were used to analyze patient mortality in a large-scale intensive care unit data set. After applying the proposed models to assess standardized modality rates and address patient-mix variability across hospitals, we detected those underperforming hospitals with higher mortality rates. Conclusions: Our research findings highlight how constructing advanced assessment tools for hospital performance could support better decision-making at the administrative and public levels. The proposed hospital compare models are comprehensive in their capacity to identify patterns of hospital random effects and to convey the variability in healthcare quality with powerful accuracy and interpretability.

Details

Language :
English
ISSN :
21682372
Volume :
11
Database :
Directory of Open Access Journals
Journal :
IEEE Journal of Translational Engineering in Health and Medicine
Publication Type :
Academic Journal
Accession number :
edsdoj.fb2158d3f054f2b921950e367f4d5fa
Document Type :
article
Full Text :
https://doi.org/10.1109/JTEHM.2023.3257179