Confidence interval estimates of an index of quality performance based on logistic regression models.

This paper considers an index of hospital quality performance defined as the ratio of the observed number deaths to the number predicted by a fitted logistic regression model. We study tests and confidence intervals under two different scenarios depending on the availability of an estimate of the covariance matrix of the coefficients from the fitted logistic regression model. We propose parametric as well as bootstrap-based confidence intervals. We apply the methods to an analysis of the performance of 27 intensive care units.

[1]  S. Lemeshow,et al.  Mortality Probability Models (MPM II) based on an international cohort of intensive care unit patients. , 1993, JAMA.

[2]  Predicting hospital-associated mortality for Medicare patients. A method for patients with stroke, pneumonia, acute myocardial infarction, and congestive heart failure. , 1988 .

[3]  D. W. Smith Evaluating risk adjustment by partitioning variation in hospital mortality rates. , 1994, Statistics in medicine.

[4]  Gail Gong Cross-Validation, the Jackknife, and the Bootstrap: Excess Error Estimation in Forward Logistic Regression , 1986 .

[5]  J. Hanley,et al.  The meaning and use of the area under a receiver operating characteristic (ROC) curve. , 1982, Radiology.

[6]  J. S. Hixson,et al.  Efficacy of Statistical Outlier Analysis for Monitoring Quality of Care , 1991 .

[7]  W. Knaus,et al.  An evaluation of outcome from intensive care in major medical centers. , 1986, Annals of internal medicine.

[8]  N T Longford,et al.  Empirical Bayes methods for estimating hospital-specific mortality rates. , 1994, Statistics in medicine.

[9]  D. Kleinbaum,et al.  Applied Regression Analysis and Other Multivariate Methods , 1978 .

[10]  S Lemeshow,et al.  Mortality probability models for patients in the intensive care unit for 48 or 72 hours: A prospective, multicenter study , 1994, Critical care medicine.

[11]  S. Lemeshow,et al.  A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study , 1993 .

[12]  D Draper,et al.  Interpreting hospital mortality data. The role of clinical risk adjustment. , 1988, JAMA.

[13]  Walter W. Hauck,et al.  A Note on Confidence Bands for the Logistic Response Curve , 1983 .

[14]  D. Cowper,et al.  The Ratio of Observed‐to‐Expected Mortality as a Quality of Care Indicator in Non‐Surgical VA Patients , 1994, Medical care.