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A Novel Approach to Evaluating Cardiac Surgery Providers: An Alternative to the RAMR
Christine Pitocco1, Thomas R Sexton1
1College of Business, Stony Brook University, Stony Brook, New York, USA.
The International Journal of Health Planning and Management
|September 29, 2021
Summary
A new method using upper and lower tail probabilities (UTP/LTP) of the binomial distribution offers an alternative to the Risk Adjusted Mortality Rate (RAMR) for evaluating healthcare provider performance in cardiac surgery.
Area of Science:
- Biostatistics
- Health Services Research
- Surgical Outcomes
Background:
- The Risk Adjusted Mortality Rate (RAMR) is used by New York State to identify underperforming cardiac surgeons and hospitals.
- Four significant concerns have been identified with the current RAMR methodology.
Purpose of the Study:
- To propose and evaluate an alternative methodology for assessing provider performance.
- To address the identified limitations of the RAMR in cardiac surgery outcomes analysis.
Main Methods:
- Utilized upper and lower tail probabilities (UTP/LTP) of the binomial distribution.
- Applied the UTP/LTP methodology to New York State cardiac surgery data from 2011-2013.
Main Results:
- The UTP/LTP approach demonstrated agreement with RAMR in classifying all surgeons and hospitals.
- The UTP/LTP method avoids strict categorization, allowing for identification of marginal providers.
Conclusions:
- The UTP/LTP methodology effectively addresses the four identified concerns with RAMR.
- This approach aligns with statistical theory, handles case volume appropriately, and does not require confidence intervals.
