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Loss function-based evaluation of physician report cards
AbstractReport cards classifying physicians into performance tiers are central to health care quality improvement initiatives. Misclassification is a concern since physicians often have small patient panels for standard performance measures. Given that report cards are used for different purposes by different stakeholders, we specify loss functions and evaluate the potential cost of misclassification for physician report card designs. Monte Carlo simulation to explore misclassification risk and cost for four illustrative physician report card designs and three loss functions representing overall misclassification, patient,...
Source: Health Services and Outcomes Research Methodology - June 1, 2018 Category: Statistics Source Type: research

Statistical testing when the populations from which samples are drawn are uncertain
AbstractThe topic of this article is hypothesis testing when the populations from which the data are drawn are known only with a given probability distribution. Some important areas of application for which such a situation arises is reviewed briefly. The specific cases herein considered are testing a one-sided hypothesis involving two populations. An illustrative small data set, involving six observations, is used to demonstrate relevant approaches and calculations for such testing. Both a frequentist approach and a Bayesian approach are developed. In both of these approaches, use is made of all possible data configuratio...
Source: Health Services and Outcomes Research Methodology - April 12, 2018 Category: Statistics Source Type: research

Comparing the spatial attractiveness of hospitals using zero-inflated spatial models
AbstractPolicy makers increasingly rely on hospital competition to incentivize patients to choose high-value care. Amongst all possible drivers, the travel distance without any doubt is one of the most important. In this paper we propose the use of a spatial Bayesian hierarchical model to assess the impact of distance on the number of patient admissions in hospitals, and thereby, compare hospital attractiveness. To this aim a MCMC sampler has been designed. We apply our methodology to patient admissions for asthma in four hospitals located in the H érault department of France. Results indicate that the most attractive...
Source: Health Services and Outcomes Research Methodology - March 6, 2018 Category: Statistics Source Type: research

Using entropy balancing to strengthen an observational cohort study design: lessons learned from an evaluation of a complex multi-state federal demonstration
AbstractWe conducted an evaluation of a patient-centered medical home demonstration sponsored by the Centers for Medicare& Medicaid Services. We implemented a quasi-experimental pre-post with a comparison group design. Traditional propensity score weighting failed to achieve balance (exchangeability) between the two groups on several critical characteristics. In response, we incorporated a relatively new alternative known as entropy balancing. Our objective is to share lessons learned from using entropy balancing in a quasi-experimental study design. We document the advantages and challenges with using entropy balancin...
Source: Health Services and Outcomes Research Methodology - March 1, 2018 Category: Statistics Source Type: research

Comparing alternative methods to measuring pedestrian access to community pharmacies
AbstractThe aim of this paper is to compare several methods for measuring geographical accessibility to community pharmacies in the Lisbon Metropolitan Area (LMA). Twelve measures of pedestrian distance between spatial units and the closest community pharmacy were computed based on the combination of 4 parameters: type of distance, location, centroid definition, and level of spatial unit. For this, the Google Maps Application Programming Interface was used for calculating network pedestrian distances, using a list of 801 community pharmacies and population data from the Census 2011. Correlations between every method were p...
Source: Health Services and Outcomes Research Methodology - March 1, 2018 Category: Statistics Source Type: research

An Exploratory Cost-Effectiveness Analysis of the Connected Health Intervention to Improve Care for People with Dementia: A Simulation Analysis
This study estimates the costs of care of dementia using time-driven activity based costing of an exemplar patient. Intervention costs and health utility values were derived from a feasibility study of the intervention. A Markov model produced estimates of the cost-effectiveness of the intervention under four scenarios: (1) a minimal effect of the intervention on disease progression; (2) moderate effects on disease progression, and minimal effects on quality of life (QOL) and cost; (3) minimal effects on disease progression and QOL, and a moderate effect on cost; (4) moderate effects on disease progression and cost, with m...
Source: Health Services and Outcomes Research Methodology - March 1, 2018 Category: Statistics Source Type: research

Adaptation and psychometric properties evaluation of the Greek version of WHODAS 2.0. pilot application in Greek elderly population
AbstractThe World Health Organization Disability Assessment Schedule (WHODAS 2.0) is the official generic assessment instrument of WHO for disability and health. It is considered to be applicable across cultures in adult populations. The paper describes the development, cultural adaptation and validation of the Greek version of the official WHODAS 2.0, 36-item assessment schedule. The research tested the psychometric properties of this version in order to identify if it can be considered a valid and reliable instrument for measuring health and disability in the Greek population and culture. Field test studies were conducte...
Source: Health Services and Outcomes Research Methodology - March 1, 2018 Category: Statistics Source Type: research

A bivariate Bernoulli model for analyzing malnutrition data
AbstractMultivariate binary responses from the same subject are usually correlated. For example, malnutrition of children are usually measured using ‘stunting’ (low height-for-age) and ‘wasting’ (low weight-for-age) calculated from their height, weight and age, and hence the status of being stunted may depend on the status of being wasted and vice-versa. For analyzing such malnutrition data, one needs special statistical models allowing for dependence between the responses to avoid misleading inference. The problem of dependence in multivariate binary responses is generally addressed by using marginal models with g...
Source: Health Services and Outcomes Research Methodology - March 1, 2018 Category: Statistics Source Type: research

Loss function-based evaluation of physician report cards
AbstractReport cards classifying physicians into performance tiers are central to health care quality improvement initiatives. Misclassification is a concern since physicians often have small patient panels for standard performance measures. Given that report cards are used for different purposes by different stakeholders, we specify loss functions and evaluate the potential cost of misclassification for physician report card designs. Monte Carlo simulation to explore misclassification risk and cost for four illustrative physician report card designs and three loss functions representing overall misclassification, patient,...
Source: Health Services and Outcomes Research Methodology - February 27, 2018 Category: Statistics Source Type: research

Using Veterans Affairs Corporate Data Warehouse to identify 30-day hospital readmissions
We examined all VA bedded stays with an admission date in 2009. Non-acute portions of a stay were dropped. VA to VA transfers were merged when consecutive discharge and admission dates were within one calendar day. Finally, hospitalizations that occurred in a non-VA facility were merged. The 30-day readmission rate was calculated at each step of t he algorithm to demonstrate the impact. The total number of VA medical hospitalizations in 2009 with live discharges was 505,861. The 30-day readmission rate after adjusting for VA to VA transfers and incorporating non-VA care was 18.3% (95% confidence interval (CI): 18.2, 18.4%)...
Source: Health Services and Outcomes Research Methodology - February 19, 2018 Category: Statistics Source Type: research

Consistent estimation of polychotomous treatment effects with selection-bias and unobserved heterogeneity using panel data correlated random coefficients model
AbstractWe estimate multiple treatment effects in presence of selection-bias and response heterogeneity, using panel data. A control function was added to a fixed-effects based correlated random coefficients model. Selection model to create the control function was contrasted between multinomial logit and multinomial probit. For the multinomial logit model, parametric and semi-parametric bias correction techniques, as proposed in Lee (Econometrica 51(2):507 –512,1983), Dubin and McFadden (Econometrica  52(2):345–362,1984) and Dahl (Econometrica 70(6):2367 –2420,2002) respectively, were implemented. We find that cont...
Source: Health Services and Outcomes Research Methodology - February 1, 2018 Category: Statistics Source Type: research

Adaptation and psychometric properties evaluation of the Greek version of WHODAS 2.0. pilot application in Greek elderly population
AbstractThe World Health Organization Disability Assessment Schedule (WHODAS 2.0) is the official generic assessment instrument of WHO for disability and health. It is considered to be applicable across cultures in adult populations. The paper describes the development, cultural adaptation and validation of the Greek version of the official WHODAS 2.0, 36-item assessment schedule. The research tested the psychometric properties of this version in order to identify if it can be considered a valid and reliable instrument for measuring health and disability in the Greek population and culture. Field test studies were conducte...
Source: Health Services and Outcomes Research Methodology - January 29, 2018 Category: Statistics Source Type: research

An Exploratory Cost-Effectiveness Analysis of the Connected Health Intervention to Improve Care for People with Dementia: A Simulation Analysis
This study estimates the costs of care of dementia using time-driven activity based costing of an exemplar patient. Intervention costs and health utility values were derived from a feasibility study of the intervention. A Markov model produced estimates of the cost-effectiveness of the intervention under four scenarios: (1) a minimal effect of the intervention on disease progression; (2) moderate effects on disease progression, and minimal effects on quality of life (QOL) and cost; (3) minimal effects on disease progression and QOL, and a moderate effect on cost; (4) moderate effects on disease progression and cost, with m...
Source: Health Services and Outcomes Research Methodology - December 15, 2017 Category: Statistics Source Type: research

Comparing alternative methods to measuring pedestrian access to community pharmacies
AbstractThe aim of this paper is to compare several methods for measuring geographical accessibility to community pharmacies in the Lisbon Metropolitan Area (LMA). Twelve measures of pedestrian distance between spatial units and the closest community pharmacy were computed based on the combination of 4 parameters: type of distance, location, centroid definition, and level of spatial unit. For this, the Google Maps Application Programming Interface was used for calculating network pedestrian distances, using a list of 801 community pharmacies and population data from the Census 2011. Correlations between every method were p...
Source: Health Services and Outcomes Research Methodology - December 12, 2017 Category: Statistics Source Type: research

Optimizing variance-bias trade-off in the TWANG package for estimation of propensity scores
In this study, we closely examine approaches to fine-tune one machine learning technique [generalized boosted models (GBM)] to select propensity scores that seek to optimize the variance-bias trade-off that is inherent in most propensity score analyses. Specifically, we propose and evaluate three approaches for selecting the optimal number of trees for the GBM in thetwang package in R. Normally, thetwang package in R iteratively selects the optimal number of trees as that which maximizes balance between the treatment groups being considered. Because the selected number of trees may lead to highly variable propensity score ...
Source: Health Services and Outcomes Research Methodology - December 1, 2017 Category: Statistics Source Type: research