Cargando…

Risk-adjustment of diabetes health outcomes improves the accuracy of performance benchmarking

Benchmarking clinical performance by comparing diabetes health outcomes across healthcare providers drives quality improvement. Non-care related patient risk factors are likely to confound clinical performance, but few studies have tested this. This cross-sectional study is the first Australian inve...

Descripción completa

Detalles Bibliográficos
Autores principales: Danek, Eleanor, Earnest, Arul, Wischer, Natalie, Andrikopoulos, Sofianos, Pease, Anthony, Nanayakkara, Natalie, Zoungas, Sophia
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Nature Publishing Group UK 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6035186/
https://www.ncbi.nlm.nih.gov/pubmed/29980691
http://dx.doi.org/10.1038/s41598-018-28101-w
_version_ 1783338001189830656
author Danek, Eleanor
Earnest, Arul
Wischer, Natalie
Andrikopoulos, Sofianos
Pease, Anthony
Nanayakkara, Natalie
Zoungas, Sophia
author_facet Danek, Eleanor
Earnest, Arul
Wischer, Natalie
Andrikopoulos, Sofianos
Pease, Anthony
Nanayakkara, Natalie
Zoungas, Sophia
author_sort Danek, Eleanor
collection PubMed
description Benchmarking clinical performance by comparing diabetes health outcomes across healthcare providers drives quality improvement. Non-care related patient risk factors are likely to confound clinical performance, but few studies have tested this. This cross-sectional study is the first Australian investigation to analyse the effect of risk-adjustment for non-care related patient factors on benchmarking. Data from 4,670 patients with type 2 (n = 3,496) or type 1 (n = 1,174) were analysed across 49 diabetes centres. Diabetes health outcomes (HbA1c levels, LDL-cholesterol levels, systolic blood pressure and rates of severe hypoglycaemia) were risk-adjusted for non-care related patient factors using multivariate stepwise linear and logistic regression models. Unadjusted and risk-adjusted funnel plots were constructed for each outcome to identify low-performing and high-performing outliers. Unadjusted funnel plots identified 27 low-performing outliers and 15 high-performing outliers across all diabetes health outcomes. After risk-adjustment, 22 (81%) low-performing outliers and 13 (87%) high-performing outliers became inliers. Additionally, one inlier became a low-performing outlier. Risk-adjustment of diabetes health outcomes significantly reduced false positives and false negatives for outlier performance, hence providing more accurate information to guide quality improvement activity.
format Online
Article
Text
id pubmed-6035186
institution National Center for Biotechnology Information
language English
publishDate 2018
publisher Nature Publishing Group UK
record_format MEDLINE/PubMed
spelling pubmed-60351862018-07-12 Risk-adjustment of diabetes health outcomes improves the accuracy of performance benchmarking Danek, Eleanor Earnest, Arul Wischer, Natalie Andrikopoulos, Sofianos Pease, Anthony Nanayakkara, Natalie Zoungas, Sophia Sci Rep Article Benchmarking clinical performance by comparing diabetes health outcomes across healthcare providers drives quality improvement. Non-care related patient risk factors are likely to confound clinical performance, but few studies have tested this. This cross-sectional study is the first Australian investigation to analyse the effect of risk-adjustment for non-care related patient factors on benchmarking. Data from 4,670 patients with type 2 (n = 3,496) or type 1 (n = 1,174) were analysed across 49 diabetes centres. Diabetes health outcomes (HbA1c levels, LDL-cholesterol levels, systolic blood pressure and rates of severe hypoglycaemia) were risk-adjusted for non-care related patient factors using multivariate stepwise linear and logistic regression models. Unadjusted and risk-adjusted funnel plots were constructed for each outcome to identify low-performing and high-performing outliers. Unadjusted funnel plots identified 27 low-performing outliers and 15 high-performing outliers across all diabetes health outcomes. After risk-adjustment, 22 (81%) low-performing outliers and 13 (87%) high-performing outliers became inliers. Additionally, one inlier became a low-performing outlier. Risk-adjustment of diabetes health outcomes significantly reduced false positives and false negatives for outlier performance, hence providing more accurate information to guide quality improvement activity. Nature Publishing Group UK 2018-07-06 /pmc/articles/PMC6035186/ /pubmed/29980691 http://dx.doi.org/10.1038/s41598-018-28101-w Text en © The Author(s) 2018 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.
spellingShingle Article
Danek, Eleanor
Earnest, Arul
Wischer, Natalie
Andrikopoulos, Sofianos
Pease, Anthony
Nanayakkara, Natalie
Zoungas, Sophia
Risk-adjustment of diabetes health outcomes improves the accuracy of performance benchmarking
title Risk-adjustment of diabetes health outcomes improves the accuracy of performance benchmarking
title_full Risk-adjustment of diabetes health outcomes improves the accuracy of performance benchmarking
title_fullStr Risk-adjustment of diabetes health outcomes improves the accuracy of performance benchmarking
title_full_unstemmed Risk-adjustment of diabetes health outcomes improves the accuracy of performance benchmarking
title_short Risk-adjustment of diabetes health outcomes improves the accuracy of performance benchmarking
title_sort risk-adjustment of diabetes health outcomes improves the accuracy of performance benchmarking
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6035186/
https://www.ncbi.nlm.nih.gov/pubmed/29980691
http://dx.doi.org/10.1038/s41598-018-28101-w
work_keys_str_mv AT danekeleanor riskadjustmentofdiabeteshealthoutcomesimprovestheaccuracyofperformancebenchmarking
AT earnestarul riskadjustmentofdiabeteshealthoutcomesimprovestheaccuracyofperformancebenchmarking
AT wischernatalie riskadjustmentofdiabeteshealthoutcomesimprovestheaccuracyofperformancebenchmarking
AT andrikopoulossofianos riskadjustmentofdiabeteshealthoutcomesimprovestheaccuracyofperformancebenchmarking
AT peaseanthony riskadjustmentofdiabeteshealthoutcomesimprovestheaccuracyofperformancebenchmarking
AT nanayakkaranatalie riskadjustmentofdiabeteshealthoutcomesimprovestheaccuracyofperformancebenchmarking
AT zoungassophia riskadjustmentofdiabeteshealthoutcomesimprovestheaccuracyofperformancebenchmarking