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Methods for comparing center-specific survival outcomes using direct standardization.

Kevin He1, Douglas E Schaubel

  • 1Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI 48109-2029, U.S.A.

Statistics in Medicine
|January 18, 2014
PubMed
Summary
This summary is machine-generated.

Evaluating healthcare centers requires accounting for patient differences. This study introduces a new method, the standardized rate ratio (SRR), to fairly compare center outcomes using survival analysis, even with censored data.

Keywords:
Cox regressioncenter effectstandardized rate ratiostratificationsurvival analysis

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Area of Science:

  • Biostatistics
  • Health Services Research
  • Survival Analysis

Background:

  • Center-specific outcome evaluation commonly uses survival analysis.
  • Existing methods must address patient characteristic and censoring distribution imbalances.
  • Traditional hazard regression models with center indicators can be problematic.

Purpose of the Study:

  • To propose a semiparametric standardized rate ratio (SRR) for evaluating centers.
  • To ensure the evaluation measure is robust to covariate and censoring distribution differences.
  • To provide a valid and convenient method for center-specific outcome assessment.

Main Methods:

  • Development of a semiparametric version of the standardized rate ratio (SRR).
  • The SRR is defined as the ratio of expected to observed events under a center's hazard.
  • Derivation of asymptotic properties and examination of finite-sample properties via simulations.

Main Results:

  • The proposed SRR is not influenced by center-specific covariate or censoring distributions.
  • Simulation studies confirm the finite-sample properties of the SRR estimators.
  • The method was successfully applied to national kidney transplant data.

Conclusions:

  • The semiparametric SRR offers a robust approach for center-specific outcome evaluation.
  • This method addresses limitations of traditional survival analysis techniques in comparative studies.
  • The SRR provides a reliable metric for assessing performance across different healthcare centers.