risk adjustment and other reporting issues shalini santhakumaran ndau statistician imperial college...
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Risk adjustment and other reporting issues
Shalini Santhakumaran
NDAU Statistician
Imperial College London
Why report outcomes ?
Improvements in neonatal care and outcomes
Audit
Comparison
Commissioning Accountability
Transparency
Analysis issues
Unadjusted data is useful for some purposes
For others a more detailed analysis is required
Analysis issues
Unadjusted data is useful for some purposes
For others a more detailed analysis is required
3 reasons for variation in outcome:
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
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
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
Funnel plot for adjusted SMR
95% confidence interval limits = “warning”99.8% confidence interval limits = “alarm”
● = complete networks
○ = incomplete networks
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
The National Neonatal Database
Individual, not aggregated
Population-based
Detailed clinical record
Electronic
Collaborative access to denominator data
The National Neonatal Database
Individual, not aggregated
Population-based
Detailed clinical record
Electronic
Collaborative access to denominator data
…ideal for reporting outcomes