PMID- 21778493
OWN - NLM
STAT- MEDLINE
DCOM- 20111006
LR  - 20211020
IS  - 1541-0048 (Electronic)
IS  - 0090-0036 (Print)
IS  - 0090-0036 (Linking)
VI  - 101
IP  - 9
DP  - 2011 Sep
TI  - Why health care process performance measures can have different relationships to 
      outcomes for patients and hospitals: understanding the ecological fallacy.
PG  - 1635-42
LID - 10.2105/AJPH.2011.300153 [doi]
AB  - Relationships between health care process performance measures (PPMs) and 
      outcomes can differ in magnitude and even direction for patients versus higher 
      level units (e.g., health care facilities). Such discrepancies can arise because 
      facility-level relationships ignore PPM-outcome relationships for patients within 
      facilities, may have different confounders than patient-level PPM-outcome 
      relationships, and may reflect facility effect modification of patient 
      PPM-outcome relationships. If a patient-level PPM is related to better patient 
      outcomes, that care process should be encouraged. However, the finding in a 
      multilevel analysis that the proportion of patients receiving PPM care across 
      facilities nevertheless is linked to poor hospital outcomes would suggest that 
      interventions targeting the health care facility also are needed.
FAU - Finney, John W
AU  - Finney JW
AD  - Center for Health Care Evaluation, VA Palo Alto Health Care System, Menlo Park, 
      CA 94025, USA. john.finney@va.gov
FAU - Humphreys, Keith
AU  - Humphreys K
FAU - Kivlahan, Daniel R
AU  - Kivlahan DR
FAU - Harris, Alex H S
AU  - Harris AH
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Research Support, U.S. Gov't, Non-P.H.S.
DEP - 20110721
PL  - United States
TA  - Am J Public Health
JT  - American journal of public health
JID - 1254074
SB  - IM
MH  - Bias
MH  - Confounding Factors, Epidemiologic
MH  - Data Interpretation, Statistical
MH  - Environment
MH  - Health Services Administration/*statistics & numerical data
MH  - Health Services Research/methods/*statistics & numerical data
MH  - Humans
MH  - Outcome and Process Assessment, Health Care/*statistics & numerical data
MH  - Quality Indicators, Health Care/*statistics & numerical data
MH  - Substance-Related Disorders/rehabilitation
PMC - PMC3154212
EDAT- 2011/07/23 06:00
MHDA- 2011/10/07 06:00
PMCR- 2013/09/01
CRDT- 2011/07/23 06:00
PHST- 2011/07/23 06:00 [entrez]
PHST- 2011/07/23 06:00 [pubmed]
PHST- 2011/10/07 06:00 [medline]
PHST- 2013/09/01 00:00 [pmc-release]
AID - AJPH.2011.300153 [pii]
AID - 300153 [pii]
AID - 10.2105/AJPH.2011.300153 [doi]
PST - ppublish
SO  - Am J Public Health. 2011 Sep;101(9):1635-42. doi: 10.2105/AJPH.2011.300153. Epub 
      2011 Jul 21.