Document Detail

Precision of individual and composite performance scores: the ideal number of indicators in an indicator set.
MedLine Citation:
PMID:  23047127     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: In many countries, quality indicators are used to assess the quality of care of family practice. Such assessments need to have an adequate precision, so that the results can be interpreted correctly. However, a small sample size per practitioner can lead to inadequate precision. A possible solution could be to create composite performance scores.
OBJECTIVES: To evaluate the relationship between sample size and precision. We examine whether a composite performance score has an increased precision and how many indicators are needed minimally to achieve this level of precision.
RESEARCH DESIGN: We performed a descriptive statistical study on data from the medical records of 455 Dutch practices. We included 3 different conditions: diabetes (12 indicators), chronic obstructive pulmonary disease (4 indicators), and Cardiovascular Disease and Risk Management (9 indicators).
RESULTS: For individual quality indicators, patient samples close to 100 are required to achieve even moderate precision (10 percentage points) on the performance scores. This number decreases substantially when a composite score is used. A composite derived from combining 5 to 7 indicators can provide much the same precision of measurement as one made up from a much larger number of indicators.
CONCLUSIONS: The added value of a composite score depends on the a priori reasons for measuring quality. Our results indicate that especially for formative quality improvement a small number of carefully selected indicators can provide a sufficiently precise composite measure.
Arna L van Doorn-Klomberg; Jozé C C Braspenning; Remco C W Feskens; Margriet Bouma; Stephen M Campbell; David Reeves
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Medical care     Volume:  51     ISSN:  1537-1948     ISO Abbreviation:  Med Care     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2012-12-11     Completed Date:  2013-02-20     Revised Date:  2013-10-03    
Medline Journal Info:
Nlm Unique ID:  0230027     Medline TA:  Med Care     Country:  United States    
Other Details:
Languages:  eng     Pagination:  115-21     Citation Subset:  IM    
Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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MeSH Terms
Cardiovascular Diseases / prevention & control,  therapy
Diabetes Mellitus / prevention & control,  therapy
Family Practice / statistics & numerical data*
Pulmonary Disease, Chronic Obstructive / prevention & control,  therapy
Quality Indicators, Health Care / statistics & numerical data*
Quality of Health Care / statistics & numerical data
Comment In:
Med Care. 2013 Sep;51(9):854   [PMID:  23703650 ]
Med Care. 2013 Sep;51(9):854-5   [PMID:  23836099 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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