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  1. Aug 2015
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    Hospital Diagnostic Aggregation and Risk‐Adjusted Quality
    11
    1. pacoramon 10 Aug 2015
      This may be caused by a reduction in data points, or that thedifferences in risk characteristics of the various DRGs within most MDCscoincide with a metropolitan-rural divide

      This is glorious!

      alternative hypothesis discussion
    2. pacoramon 10 Aug 2015
      Quality (DRG) 1.2675 0.61

      It seems there is no statistically significant differences in the Quality measured between the two aggregation levels.

      aggregation results regression
    3. pacoramon 10 Aug 2015
      total offive variables in the frontierestimate: three input types in dollars, output in number of patient-days, andquality in estimated HSMR values.

      So this is the model translated as:

      number of patient-days(by hospital*) = HSMR value(ratio) + capital prices($) + labor($) + materials($)

      • all the co-variants are also accounted by Hospital
      frontier model DEA regression
    4. pacoramon 10 Aug 2015
      Chun Lok K. Li

      Unknown to me!

      authors
    5. pacoramon 10 Aug 2015
      Hospital quality and, in some cases, its relationship with effi-ciency differs depending on aggregations.

      They are talking about diagnosis (procedures) //activity// aggregation.

      aggregation
    6. pacoramon 10 Aug 2015
      bootstrap-adjustedTobit regression as specified by Simar and Wilson (2007

      *interesting reference! on "bootstrap-adjusted Tobit regression!

      regression methods
    7. pacoramon 10 Aug 2015
      deterministic

      Is appropriate the use of a deterministic model here? It seems to me that it will be less accurate than a probabilistic one, and that that could influence the results of the comparison of the different aggregation levels biasing the conclusions.

      frontier model DEA deterministic analysis
    8. pacoramon 10 Aug 2015
      quality-adjusted frontier analysis are available inEckermann and Coelli (2013).

      *Interesting reference for reviewing!

      references frontier model
    9. pacoramon 10 Aug 2015
      Details of the estimationprocess can be found in operations research textbooks (e.g., Banker, Charnes,and Cooper 1984; Ramanathran and Ramanathan 2003)

      *Interesting reference for reviewing!

      references DEA frontier model
    10. pacoramon 10 Aug 2015
      main weakness of HSMR

      There are many others as mentioned in the previous literature references.

      HSMR
    11. pacoramon 10 Aug 2015
      The Hospital Standardized Mortality Ratio (HSMR)

      Commenting on the fallacy of the HSMR as a 'quality measure' Med Care. 2012 Aug;50(8):662-7. doi: 10.1097/MLR.0b013e31824ebd9f. The hospital standardized mortality ratio fallacy: a narrative review. van Gestel YR1, Lemmens VE, Lingsma HF, de Hingh IH, Rutten HJ, Coebergh JW.

      The death of death rates? BMJ 2015; 351 doi: http://dx.doi.org/10.1136/bmj.h3466 (Published 14 July 2015) Cite this as: BMJ 2015;351:h3466 By Tim Doran, Karen Bloor, and Alan Maynard

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