AHRQ Grant HS021860: Related Publication Summaries

Better-than-average and worse-than-average hospitals may not significantly differ from average hospitals: An analysis of Medicare Hospital Compare ratings

Paddock SM, Adams JL, Hoces de la Guardia F.
BMJ Quality & Safety 2015 Feb; 24(2):128-134.

These authors used cross-sectional data from Medicare Hospital Compare on three mortality and three readmission outcome measures to compare each provider in the top or bottom performance tier with those in the middle tier. They found that better-than-average and worse-than-average hospitals may not significantly differ from average hospitals. Their analyses illustrate the need for further innovations in quality measurement approaches used in public report cards so that consumers and other audiences can accurately distinguish between higher- and lower-quality providers.

Statistical benchmarks for health care provider performance assessment: a comparison of standard approaches to a hierarchical Bayesian histogram-based method

Paddock SM.
Health Services Research 2014 June; 49(3):1056-73.

The author compares histogram-based statistical benchmarking to other more widely used statistical benchmarking methods to demonstrate whether and how their performance differs, both in terms of setting a performance benchmark and also in terms of which providers are identified as exceeding the performance benchmark. Her study uses publicly available data from 3,240 hospitals on two process-of-care measures.

What role does efficiency play in understanding the relationship between cost and quality in physician organizations?

Paddock SM, Damberg CL, Yanagihara D, Adams JL, Burgette L, Escarce JJ.
Medical Care 2017 Dec;55(12):1039-1045.

Previous studies demonstrate overuse of a narrow set of services, suggesting provider inefficiency. However, existing studies neither quantify inefficiency more broadly nor assess its variation across physician organizations (POs). This study found that POs had substantial variation in efficiency, producing widely differing levels of quality for the same cost.

Misclassification risk of tier-based physician quality performance systems

Adams JL, Paddock SM.
Health Services Research 2017 Aug;52(4):1277-1296.

The authors estimated misclassification rates for two-category high-quality physician identification systems. They found that current methods for profiling physicians on quality may produce misleading results, and that misclassification is a policy-relevant measure of the potential impact of tiering on providers, payers, and patients. They concluded that quantifying misclassification rates should inform the construction of high-performance networks and quality improvement initiatives.

Loss function-based evaluation of physician report cards

de la Guardia FH, Hwang J, Adams JL, Paddock SM.
Health Services Outcomes Research Methods 2018 Jun;18(2):96-108.

The authors specified loss functions and evaluated the potential cost of misclassification for physician report card designs. They found that misclassification cost depends on how performance information will be used and by whom, and that selecting the lowest-cost design for a given stakeholder could maximize the usefulness of physician performance data. They concluded that misclassification cost could guide report card design, improving the usefulness of a report card for one stakeholder without disadvantaging others.