Risk adjustment and other reporting issues
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Transcript of Risk adjustment and other reporting issues
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Risk adjustment and other reporting issues
Shalini Santhakumaran
NDAU Statistician
Imperial College London
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Why report outcomes ?
Improvements in neonatal care and outcomes
Audit
Comparison
Commissioning Accountability
Transparency
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Data Issues
Completeness
Accuracy
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Data Issues
Completeness
Accuracy
Agreed case definitions
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Data Issues
Completeness
Accuracy
Agreed case definitions Neonatal transfers
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Analysis issues
Unadjusted data is useful for some purposes
For others a more detailed analysis is required
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Analysis issues
Unadjusted data is useful for some purposes
For others a more detailed analysis is required
3 reasons for variation in outcome:
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Analysis issues
Unadjusted data is useful for some purposes
For others a more detailed analysis is required
3 reasons for variation in outcome:
1. Differences in case-mix
2. Random variation
3. Differences in care provided
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Analysis issues
1. Differences in case-mix
2. Random variation
3. Differences in care provided
Selection of variables
Use of appropriate statistical models
Cannot completely control for case-mix
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Survival Probability Calculator
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Survival Probability Calculator
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Survival Probability Calculator
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Analysis issues
1. Differences in case-mix
2. Random variation
3. Differences in care provided
Occurs by chance even if the underlying mortality rate is the same for all providers
Illustrate significance using funnel plots
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Funnel plot for adjusted SMR
95% confidence interval limits = “warning”99.8% confidence interval limits = “alarm”
● = complete networks
○ = incomplete networks
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Analysis issues
1. Differences in case-mix
2. Random variation
3. Differences in care provided
Not necessarily due to good/poor performance
‘Constant risk fallacy’ and other local effects
Cannot tell us whether deaths were preventable
Needs to be linked to process measures
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The National Neonatal Database
Individual, not aggregated
Population-based
Detailed clinical record
Electronic
Collaborative access to denominator data
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The National Neonatal Database
Individual, not aggregated
Population-based
Detailed clinical record
Electronic
Collaborative access to denominator data
…ideal for reporting outcomes
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Acknowledgements
All neonatal units contributing to the NDAU
NDAU Team
NDAU Steering BoardJane Abbott (BLISS) Jacquie Kemp
Prof. Peter Brocklehurst Prof. Azeem Majeed
Prof. Kate Costeloe Prof. Neena Modi
Prof. Liz Draper Prof. Andrew Wilkinson
Imperial College London Academic Neonatal Medicine Unit