Case-Mix Adjustment of Multidimensional Patient-Reported Outcomes to Assess Hospital Performance

Area of Science:

• Health Services Research
• Biostatistics
• Patient-Reported Outcomes

Background:

• Multidimensional patient-reported outcome measures (PROMs) are vital for assessing healthcare provider performance.
• Accurate comparisons necessitate case-mix adjustment to account for patient differences.
• Current methods often aggregate PROM data into summary scores before adjustment.

Purpose of the Study:

• To develop and evaluate a dimension-specific adjustment methodology for healthcare performance assessment using PROMs.
• To compare the performance of dimension-specific adjustment against traditional summary score adjustment.
• To identify factors influencing the choice between methodologies in applied research.

Main Methods:

• Developed a dimension-specific adjustment methodology extending prior work.
• Conducted a simulation study to compare methodologies' ability to identify provider performance.
• Applied both methods to a real-world case study of knee replacement surgery in the English NHS.

Main Results:

• The dimension-specific approach demonstrated superior performance in identifying provider performance compared to the summary score approach in most simulations.
• Differences in performance between the two methods were generally small.
• The case study illustrated the practical application and findings of both methodologies.

Conclusions:

• Dimension-specific adjustment offers advantages in retaining granular information and potentially improving performance assessment.
• The choice of methodology should balance performance accuracy with implementation ease and data detail.
• Both methods are viable, but the domain-specific approach provides richer insights for stakeholders.