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Health-care quality registers: outcome-orientated ranking of hospitals is unreliable.

Ranstam, Jonas LU ; Wagner, P; Robertsson, Otto LU and Lidgren, Lars LU (2008) In Journal of Bone and Joint Surgery 90(12). p.1558-1561
Abstract
Public disclosure of outcome-orientated ranking of hospitals is becoming increasingly popular and is routinely used by Swedish health-care authorities. Whereas uncertainty about an outcome is usually presented with 95% confidence intervals, ranking's based on the same outcome are typically presented without any concern for bias or statistical precision. In order to study the effect of incomplete registration of re-operation on hospital ranking we performed a simulation study using published data on the two-year risk of re-operation after total hip replacement. This showed that whereas minor registration incompleteness has little effect on the observed risk of revision, it can lead to major errors in the ranking of hospitals. We doubt... (More)
Public disclosure of outcome-orientated ranking of hospitals is becoming increasingly popular and is routinely used by Swedish health-care authorities. Whereas uncertainty about an outcome is usually presented with 95% confidence intervals, ranking's based on the same outcome are typically presented without any concern for bias or statistical precision. In order to study the effect of incomplete registration of re-operation on hospital ranking we performed a simulation study using published data on the two-year risk of re-operation after total hip replacement. This showed that whereas minor registration incompleteness has little effect on the observed risk of revision, it can lead to major errors in the ranking of hospitals. We doubt whether a level of data entry sufficient to generate a correct ranking can be achieved, and recommend that when ranking hospitals, the uncertainties about data quality and random events should be clearly described as an integral part of the results. (Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Registries: standards, Reoperation: statistics & numerical data, Outcome Assessment (Health Care): standards, Outcome Assessment (Health Care): methods, Hospitals: standards, Hip: statistics & numerical data, Replacement, Arthroplasty, Hospitals: classification
in
Journal of Bone and Joint Surgery
volume
90
issue
12
pages
1558 - 1561
publisher
British Editorial Society of Bone & Joint Surgery
external identifiers
  • wos:000261253800003
  • pmid:19043124
  • scopus:57149093444
ISSN
2044-5377
DOI
10.1302/0301-620X.90B12.21172
language
English
LU publication?
yes
id
450d4d96-27cf-4dee-83ea-3f567cbe1121 (old id 1276646)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/19043124?dopt=Abstract
date added to LUP
2009-01-09 08:39:52
date last changed
2017-08-20 04:39:33
@article{450d4d96-27cf-4dee-83ea-3f567cbe1121,
  abstract     = {Public disclosure of outcome-orientated ranking of hospitals is becoming increasingly popular and is routinely used by Swedish health-care authorities. Whereas uncertainty about an outcome is usually presented with 95% confidence intervals, ranking's based on the same outcome are typically presented without any concern for bias or statistical precision. In order to study the effect of incomplete registration of re-operation on hospital ranking we performed a simulation study using published data on the two-year risk of re-operation after total hip replacement. This showed that whereas minor registration incompleteness has little effect on the observed risk of revision, it can lead to major errors in the ranking of hospitals. We doubt whether a level of data entry sufficient to generate a correct ranking can be achieved, and recommend that when ranking hospitals, the uncertainties about data quality and random events should be clearly described as an integral part of the results.},
  author       = {Ranstam, Jonas and Wagner, P and Robertsson, Otto and Lidgren, Lars},
  issn         = {2044-5377},
  keyword      = {Registries: standards,Reoperation: statistics & numerical data,Outcome Assessment (Health Care): standards,Outcome Assessment (Health Care): methods,Hospitals: standards,Hip: statistics & numerical data,Replacement,Arthroplasty,Hospitals: classification},
  language     = {eng},
  number       = {12},
  pages        = {1558--1561},
  publisher    = {British Editorial Society of Bone & Joint Surgery},
  series       = {Journal of Bone and Joint Surgery},
  title        = {Health-care quality registers: outcome-orientated ranking of hospitals is unreliable.},
  url          = {http://dx.doi.org/10.1302/0301-620X.90B12.21172},
  volume       = {90},
  year         = {2008},
}