Measuring Quality for Public Reporting of Health Provider Quality: Making It Meaningful to Patients

Health Policy Research Institute, University of California-Irvine, 100 Theory, Suite 110, Irvine, CA 92697-5800, USA.
American Journal of Public Health (Impact Factor: 4.55). 12/2009; 100(2):264-9. DOI: 10.2105/AJPH.2008.153759
Source: PubMed


Public quality reports of hospitals, health plans, and physicians are being used to promote efficiency and quality in the health care system. Shrinkage estimators have been proposed as superior measures of quality to be used in these reports because they offer more conservative and stable quality ranking of providers than traditional, nonshrinkage estimators. Adopting the perspective of a patient faced with choosing a local provider on the basis of publicly provided information, we examine the advantages and disadvantages of shrinkage and nonshrinkage estimators and contrast the information made available by them. We demonstrate that 2 properties of shrinkage estimators make them less useful than nonshrinkage estimators for patients making choices in their area of residence.

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    • "In thinking about shrinkage, the notation of Morris (1983) and more recently Dimick et al. (2009) and Mukamel et al. (2010) is helpful. One can describe the extent of shrinkage by writing P 5 lO1(1 À l)E where for each hospital, we solve for l after being given P, O, and E. This is a descriptive tool and not the mathematical formula used to create the shrinkage (see Gelman et al. 1997, chapter 14 for details). "
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