Cross-sectoral comparisons of process quality indicators of health care across residential regions using restricted mean survival time

Šinkovec, Hana (author), Gall, Walter E. (author), Heinze, Georg (author)

Background: Practice guidelines recommend patient management based on scientific evidence. Quality indicators gauge adherence to such recommendations and assess health care quality. They are usually defined as adverse event rates, which may not fully capture guideline adherence over time. Methods: For assessing process indicators where compliance to the recommended treatment can be assessed by evaluating a patient's trace in linked routine databases, we propose using restricted mean survival time or restricted mean time lost, which are applicable even in competing risk situations. We demonstrate their application by assessing the compliance of patients with acute myocardial infarction (AMI) to high-power statins over 12 months in Austria’s political districts, using pseudo-observations and employing causal inference methods to achieve regional comparability. Results: We analyzed the compliance of 31,678 AMI patients from Austria’s 116 political districts with index AMI between 2011 and 2015. The results revealed considerable compliance variations across districts but also plausible spatial similarities. Conclusions: Restricted mean survival time and restricted mean time lost provide interpretable estimates of patients’ expected time in compliance (lost), well-suited for risk-adjusted entity comparisons in the presence of (measurable) confounding, censoring, and competing risks.

• Language: English
• Keywords: health care provider comparisons, pseudo-observations, risk adjustment, restricted mean survival time, restricted mean time lost
• Work type: Article
• Typology: 1.01 - Original Scientific Article
• Organization: BF - Biotechnical Faculty
• Publication status: Published
• Publication version: Version of Record
• Year: 2024
• Number of pages: Str. 748-756
• Numbering: Vol. 62, no. 11
• PID: 20.500.12556/RUL-164077
• UDC: 61
• ISSN on article: 0025-7079
• DOI: 10.1097/MLR.0000000000002057
• COBISS.SI-ID: 211696643
• Publication date in RUL: 16.10.2024

Record is a part of a journal

• Title: Medical care
• Shortened title: Med. care
• Publisher: Lippincott
• ISSN: 0025-7079
• COBISS.SI-ID: 25921280

Licences

• License: CC BY 4.0, Creative Commons Attribution 4.0 International
• Link: http://creativecommons.org/licenses/by/4.0/
• Description: This is the standard Creative Commons license that gives others maximum freedom to do what they want with the work as long as they credit the author.

Secondary language

• Language: Slovenian
• Keywords: kakovost zdravstvene oskrbe, ponudniki zdravstvenih storitev, pseudo-opazovanja, prilagoditev tveganja

Projects

• Funder: Other - Other funder or multiple funders
• Funding programme: Main Association of the Austrian Social Security Institutions
• Name: Fundation