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Statistical methods for healthcare regulation: rating, screening and surveillance
Author(s) -
Spiegelhalter David,
SherlawJohnson Christopher,
Bardsley Martin,
Blunt Ian,
Wood Christopher,
Grigg Olivia
Publication year - 2012
Publication title -
journal of the royal statistical society: series a (statistics in society)
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.103
H-Index - 84
eISSN - 1467-985X
pISSN - 0964-1998
DOI - 10.1111/j.1467-985x.2011.01010.x
Subject(s) - standardization , health care , accountability , statistical hypothesis testing , statistical process control , process (computing) , computer science , statistical analysis , process management , risk analysis (engineering) , operations management , business , statistics , economics , mathematics , political science , law , economic growth , operating system
Summary. Current demand for accountability and efficiency of healthcare organizations, combined with the greater availability of routine data on clinical care and outcomes, has led to an increased focus on statistical methods in healthcare regulation. We consider three different regulatory functions in which statistical analysis plays a vital role: rating organizations, deciding whom to inspect and continuous surveillance for arising problems. A common approach to data standardization based on (possibly overdispersed) Z ‐scores is proposed, although specific tools are used for assessing performance against a target, combining indicators when screening for inspection, and continuous monitoring using risk‐adjusted sequential testing procedures. We pay particular attention to the problem of simultaneously monitoring over 2 indicators for excess mortality, both with respect to the statistical issues surrounding massive multiplicity, and the organizational aspects of dealing with such a complex but high profile process.