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HERC Health Economics Seminar

Are Misinterpreted, Hospital-level Relationships Between Process Performance Measures and Outcomes Undermining Evidence-based Patient Care?

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Seminar date: 5/22/2013

Description: Some health care process performance measures are being questioned following the publication of multiple studies finding no or weak relationships between those measures and clinical outcomes in hospital-level analyses. For example, some clinicians are asking why they should be held accountable to certain performance measures in the light of such findings? The presentation will point out that hospital-level results do not indicate whether, at the patient level, there is a positive, negative or null relationship between receipt of the recommended practice(s) and positive outcomes. Indeed, it is an “ecological fallacy” to assume that relationships at the patient level mirror relationships found at the hospital level. The presentation will explain how and why discrepancies can arise in relationships between process performance measures and outcomes at the patient and hospital levels. It also will discuss the appropriateness of multilevel analyses for evaluating relationships of process performance measures to clinical outcomes, as well as the need for performance measure bodies to provide data for multilevel analyses.

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