Abstract:
:Studies finding weak or nonexistent relationships between hospital performance on providing recommended care and hospital-level clinical outcomes raise questions about the value and validity of process of care performance measures. Such findings may cause clinicians to question the effectiveness of the care process presumably captured by the performance measure. However, one cannot infer from hospital-level results whether patients who received the specified care had comparable, worse or superior outcomes relative to patients not receiving that care. To make such an inference has been labeled the "ecological fallacy," an error that is well known among epidemiologists and sociologists, but less so among health care researchers and policy makers. We discuss such inappropriate inferences in the health care performance measurement field and illustrate how and why process measure-outcome relationships can differ at the patient and hospital levels. We also offer recommendations for appropriate multilevel analyses to evaluate process measure-outcome relationships at the patient and hospital levels and for a more effective role for performance measure bodies and research funding organizations in encouraging such multilevel analyses.
journal_name
J Gen Intern Medjournal_title
Journal of general internal medicineauthors
Finney JW,Humphreys K,Kivlahan DR,Harris AHdoi
10.1007/s11606-015-3564-3subject
Has Abstractpub_date
2016-04-01 00:00:00pages
74-7eissn
0884-8734issn
1525-1497pii
10.1007/s11606-015-3564-3journal_volume
31 Suppl 1pub_type
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journal_title:Journal of general internal medicine
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