A quality indicator can be biased by intra-hospital heterogeneity: the case for quality of patient record keeping in France.
Eur J Public Health
; 25(5): 787-91, 2015 Oct.
Article
em En
| MEDLINE
| ID: mdl-25983328
ABSTRACT
BACKGROUND:
Since 2008, French health institutions providing medical, surgical and obstetrical care are assessed on the basis of a set of quality indicators. The French National Authority for Health developed a survey design in which 80 records are randomly selected from each institution. The main aim was to assess the effects of internal heterogeneity of a hospital that comprises several units. The survey method is based on the hypothesis of intra-institution homogeneity, which overlooks the fact that in wide hospitals homogeneity is related to departments and thus leads to overall intra-hospital heterogeneity.METHODS:
Simulated databases were created to modelise the heterogeneity of our hospital and computed to assess the reliance of indicator measurement. We used real data from a large teaching hospital having internal heterogeneity related to each department.RESULTS:
Variance under heterogeneity was greater than under homogeneity (3- to 18-fold) leading to an increased size of the confidence interval (CI) (at 95%) from 9 (given Haute Autorité de Santé sources) to 22 (for greatest internal heterogeneity).CONCLUSIONS:
The variations in a quality indicator can be explained by intra-institution heterogeneity and are not related to changes in the quality policy of the hospitals and may lead to errors in terms of pay for performance.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Viés
/
Prontuários Médicos
/
Indicadores de Qualidade em Assistência à Saúde
/
Departamentos Hospitalares
/
Hospitais
Tipo de estudo:
Prognostic_studies
Limite:
Humans
País como assunto:
Europa
Idioma:
En
Ano de publicação:
2015
Tipo de documento:
Article