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Is there much variation in variation? Revisiting statistics of small area variation in health services research

BACKGROUND: The importance of Small Area Variation Analysis for policy-making contrasts with the scarcity of work on the validity of the statistics used in these studies. Our study aims at 1) determining whether variation in utilization rates between health areas is higher than would be expected by...

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Autores principales: Ibáñez, Berta, Librero, Julián, Bernal-Delgado, Enrique, Peiró, Salvador, López-Valcarcel, Beatriz González, Martínez, Natalia, Aizpuru, Felipe
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2009
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2676262/
https://www.ncbi.nlm.nih.gov/pubmed/19341469
http://dx.doi.org/10.1186/1472-6963-9-60
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author Ibáñez, Berta
Librero, Julián
Bernal-Delgado, Enrique
Peiró, Salvador
López-Valcarcel, Beatriz González
Martínez, Natalia
Aizpuru, Felipe
author_facet Ibáñez, Berta
Librero, Julián
Bernal-Delgado, Enrique
Peiró, Salvador
López-Valcarcel, Beatriz González
Martínez, Natalia
Aizpuru, Felipe
author_sort Ibáñez, Berta
collection PubMed
description BACKGROUND: The importance of Small Area Variation Analysis for policy-making contrasts with the scarcity of work on the validity of the statistics used in these studies. Our study aims at 1) determining whether variation in utilization rates between health areas is higher than would be expected by chance, 2) estimating the statistical power of the variation statistics; and 3) evaluating the ability of different statistics to compare the variability among different procedures regardless of their rates. METHODS: Parametric bootstrap techniques were used to derive the empirical distribution for each statistic under the hypothesis of homogeneity across areas. Non-parametric procedures were used to analyze the empirical distribution for the observed statistics and compare the results in six situations (low/medium/high utilization rates and low/high variability). A small scale simulation study was conducted to assess the capacity of each statistic to discriminate between different scenarios with different degrees of variation. RESULTS: Bootstrap techniques proved to be good at quantifying the difference between the null hypothesis and the variation observed in each situation, and to construct reliable tests and confidence intervals for each of the variation statistics analyzed. Although the good performance of Systematic Component of Variation (SCV), Empirical Bayes (EB) statistic shows better behaviour under the null hypothesis, it is able to detect variability if present, it is not influenced by the procedure rate and it is best able to discriminate between different degrees of heterogeneity. CONCLUSION: The EB statistics seems to be a good alternative to more conventional statistics used in small-area variation analysis in health service research because of its robustness.
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spelling pubmed-26762622009-05-03 Is there much variation in variation? Revisiting statistics of small area variation in health services research Ibáñez, Berta Librero, Julián Bernal-Delgado, Enrique Peiró, Salvador López-Valcarcel, Beatriz González Martínez, Natalia Aizpuru, Felipe BMC Health Serv Res Research Article BACKGROUND: The importance of Small Area Variation Analysis for policy-making contrasts with the scarcity of work on the validity of the statistics used in these studies. Our study aims at 1) determining whether variation in utilization rates between health areas is higher than would be expected by chance, 2) estimating the statistical power of the variation statistics; and 3) evaluating the ability of different statistics to compare the variability among different procedures regardless of their rates. METHODS: Parametric bootstrap techniques were used to derive the empirical distribution for each statistic under the hypothesis of homogeneity across areas. Non-parametric procedures were used to analyze the empirical distribution for the observed statistics and compare the results in six situations (low/medium/high utilization rates and low/high variability). A small scale simulation study was conducted to assess the capacity of each statistic to discriminate between different scenarios with different degrees of variation. RESULTS: Bootstrap techniques proved to be good at quantifying the difference between the null hypothesis and the variation observed in each situation, and to construct reliable tests and confidence intervals for each of the variation statistics analyzed. Although the good performance of Systematic Component of Variation (SCV), Empirical Bayes (EB) statistic shows better behaviour under the null hypothesis, it is able to detect variability if present, it is not influenced by the procedure rate and it is best able to discriminate between different degrees of heterogeneity. CONCLUSION: The EB statistics seems to be a good alternative to more conventional statistics used in small-area variation analysis in health service research because of its robustness. BioMed Central 2009-04-02 /pmc/articles/PMC2676262/ /pubmed/19341469 http://dx.doi.org/10.1186/1472-6963-9-60 Text en Copyright © 2009 Ibáñez et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( (http://creativecommons.org/licenses/by/2.0) ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Ibáñez, Berta
Librero, Julián
Bernal-Delgado, Enrique
Peiró, Salvador
López-Valcarcel, Beatriz González
Martínez, Natalia
Aizpuru, Felipe
Is there much variation in variation? Revisiting statistics of small area variation in health services research
title Is there much variation in variation? Revisiting statistics of small area variation in health services research
title_full Is there much variation in variation? Revisiting statistics of small area variation in health services research
title_fullStr Is there much variation in variation? Revisiting statistics of small area variation in health services research
title_full_unstemmed Is there much variation in variation? Revisiting statistics of small area variation in health services research
title_short Is there much variation in variation? Revisiting statistics of small area variation in health services research
title_sort is there much variation in variation? revisiting statistics of small area variation in health services research
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2676262/
https://www.ncbi.nlm.nih.gov/pubmed/19341469
http://dx.doi.org/10.1186/1472-6963-9-60
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