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Performance Evaluations and League Tables: Do They Capture Variation Between Organizational Units? An Analysis of 5 Swedish Pharmacological Performance Indicators.

Ohlsson, Henrik LU ; Librero, Julian LU ; Sundquist, Jan LU ; Sundquist, Kristina LU and Merlo, Juan LU (2011) In Medical Care Online 49(3). p.327-331
Abstract
BACKGROUND:: The use of league tables during the last decade has frequently been employed to assess quality in health care. However, few studies have attempted to assess quality by quantifying the variability across the organizational units or attempted to investigate whether the units are the correct context that really influences the outcome under study. OBJECTIVES:: To quantify the variation between different organizational units regarding 5 different Swedish national pharmacological performance indicators and to examine whether the organizational units under study are a valid construct of the context that influences the specific outcome. RESEARCH DESIGN:: A multilevel model with patients nested within health care units that in turn... (More)
BACKGROUND:: The use of league tables during the last decade has frequently been employed to assess quality in health care. However, few studies have attempted to assess quality by quantifying the variability across the organizational units or attempted to investigate whether the units are the correct context that really influences the outcome under study. OBJECTIVES:: To quantify the variation between different organizational units regarding 5 different Swedish national pharmacological performance indicators and to examine whether the organizational units under study are a valid construct of the context that influences the specific outcome. RESEARCH DESIGN:: A multilevel model with patients nested within health care units that in turn were nested within County councils was used. By using measures of variance (intraclass correlation [ICC]), we quantified the extent to which the 5 indicators of health care quality were conditioned by the specified units. RESULTS:: For all 5 studied indicators, the variation between county councils was small (ICC ranged from 2% to 7%), whereas the variation among health care units seemed to be more important (ICC ranged from 20% to 40%). CONCLUSION:: As the variation between county councils was small, using league tables for performance evaluation seems to be inappropriate. If league tables are to be presented, the relative size of the variation at the higher levels and an analysis regarding the possible influence of the context for the specific outcome should be included. This approach provides useful information for identifying relevant contexts to capture health care variation. (Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Medical Care Online
volume
49
issue
3
pages
327 - 331
publisher
Lippincott Williams & Wilkins
external identifiers
  • wos:000287240300015
  • pmid:21263360
  • scopus:79951680386
ISSN
1537-1948
DOI
10.1097/MLR.0b013e31820325c5
language
English
LU publication?
yes
id
34c6734e-89bb-4275-8810-90140864b2b9 (old id 1777082)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/21263360?dopt=Abstract
date added to LUP
2011-02-01 09:21:44
date last changed
2017-03-19 03:54:49
@article{34c6734e-89bb-4275-8810-90140864b2b9,
  abstract     = {BACKGROUND:: The use of league tables during the last decade has frequently been employed to assess quality in health care. However, few studies have attempted to assess quality by quantifying the variability across the organizational units or attempted to investigate whether the units are the correct context that really influences the outcome under study. OBJECTIVES:: To quantify the variation between different organizational units regarding 5 different Swedish national pharmacological performance indicators and to examine whether the organizational units under study are a valid construct of the context that influences the specific outcome. RESEARCH DESIGN:: A multilevel model with patients nested within health care units that in turn were nested within County councils was used. By using measures of variance (intraclass correlation [ICC]), we quantified the extent to which the 5 indicators of health care quality were conditioned by the specified units. RESULTS:: For all 5 studied indicators, the variation between county councils was small (ICC ranged from 2% to 7%), whereas the variation among health care units seemed to be more important (ICC ranged from 20% to 40%). CONCLUSION:: As the variation between county councils was small, using league tables for performance evaluation seems to be inappropriate. If league tables are to be presented, the relative size of the variation at the higher levels and an analysis regarding the possible influence of the context for the specific outcome should be included. This approach provides useful information for identifying relevant contexts to capture health care variation.},
  author       = {Ohlsson, Henrik and Librero, Julian and Sundquist, Jan and Sundquist, Kristina and Merlo, Juan},
  issn         = {1537-1948},
  language     = {eng},
  number       = {3},
  pages        = {327--331},
  publisher    = {Lippincott Williams & Wilkins},
  series       = {Medical Care Online},
  title        = {Performance Evaluations and League Tables: Do They Capture Variation Between Organizational Units? An Analysis of 5 Swedish Pharmacological Performance Indicators.},
  url          = {http://dx.doi.org/10.1097/MLR.0b013e31820325c5},
  volume       = {49},
  year         = {2011},
}