Guidelines on constructing funnel plots for quality indicators: A case study on mortality in intensive care unit
Ilona Wm Verburg1,2, Rebecca Holman1,2,3, Niels Peek4
11 Academic Medical Center, University of Amsterdam, Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
Statistical Methods in Medical Research
|March 24, 2017
Summary
This study offers workflow-based guidance for constructing accurate funnel plots to assess healthcare quality indicators. Following these steps ensures reliable data interpretation and prevents critical decision-making errors.
Area of Science:
- Health Services Research
- Biostatistics
- Quality Improvement
Background:
- Funnel plots are crucial for evaluating healthcare performance against benchmarks.
- Inaccurate funnel plot construction can lead to severe consequences in clinical decision-making.
- Standardized procedures are needed for reliable quality indicator assessment.
Purpose of the Study:
- To provide workflow-based guidance for constructing funnel plots for binary quality indicators.
- To ensure accurate assessment and comparison of clinical performance among healthcare providers.
- To aid data analysts, registries, and organizations in adhering to standard operating procedures for quality indicators.
Main Methods:
- Development of a six-step workflow for funnel plot construction.
- Guidelines cover policy input, case-mix model quality, sample size, overdispersion, and indicator associations.
- Illustration using data from the Dutch National Intensive Care Evaluation registry.
Main Results:
- The proposed guidelines offer a systematic approach to funnel plot construction.
- The methodology addresses potential pitfalls in assessing binary quality indicators.
- The approach is applicable to proportions, risk-adjusted rates, and standardized rates.
Conclusions:
- Adherence to these guidelines promotes accurate funnel plot creation.
- Standardized funnel plot construction enhances the reliability of quality indicator evaluation.
- The guidance supports organizations seeking certification and robust quality assessment.
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