PMID- 38048040
OWN - NLM
STAT- MEDLINE
DCOM- 20231205
LR  - 20231216
IS  - 2509-8020 (Electronic)
IS  - 2509-8020 (Linking)
VI  - 7
IP  - 1
DP  - 2023 Dec 4
TI  - Case-mix adjustments for patient reported experience and outcome measures in 
      primary care: an empirical approach to identify patient characteristics as 
      case-mix adjusters based on a secondary analysis of an international survey among 
      patients and their general practitioners in 34 countries.
PG  - 127
LID - 10.1186/s41687-023-00667-8 [doi]
LID - 127
AB  - BACKGROUND: Case-mix adjustment of patient reported experiences (PREMs) and 
      outcomes (PROMs) of care are meant to enable fair comparison between units (e.g. 
      care providers or countries) and to show where improvement is possible. It is 
      important to distinguish between fair comparison and improvement potential, as 
      case-mix adjustment may mask improvement potential. Case-mix adjustment takes 
      into account the effect of patient characteristics that are related to the PREMs 
      and PROMs studied, but are outside the sphere of influence of the units being 
      compared. We developed an approach to assess which patient characteristics would 
      qualify as case-mix adjusters, using data from an international primary care 
      study. RESULTS: We used multilevel analysis, with patients nested in general 
      practices nested in countries. Case-mix adjustment is indicated under the 
      following conditions: there is a main effect of the potential case-mix adjuster 
      on the PREM/PROM; this effect does not vary between units; and the distribution 
      of the potential case-mix adjuster differs between units. Random slope models 
      were used to assess whether the impact of a potential case-mix adjuster varied 
      between units. To assess whether a slope variance is big enough to decide that 
      case-mix adjustment is not indicated, we compared the variances in the categories 
      of a potential case-mix adjuster. Significance of the slope variance is not 
      enough, because small variances may be significantly different from zero when 
      numbers are large. We therefore need an additional criterion to consider a slope 
      variance as important. Borrowing from the idea of a minimum clinically important 
      difference (MCID) we proposed a difference between the variances of 0.25*variance 
      (equivalent to a medium effect size). We applied this approach to data from the 
      QUALICOPC (Quality and costs of primary care in Europe) study. CONCLUSIONS: Our 
      approach provides guidance to decide whether or not patient characteristics 
      should be considered as case-mix adjusters. The criterion of a difference between 
      variances of 0.25*variance works well for continuous PREMs and PROMs, but seems 
      to be too strict for binary PREMs and PROMs. Without additional information, it 
      is not possible to decide whether important slope variation is the result of 
      either differences in performance between general practices or countries, or 
      cultural differences.
CI  - (c) 2023. The Author(s).
FAU - Groenewegen, Peter P
AU  - Groenewegen PP
AUID- ORCID: 0000-0003-2127-8442
AD  - Nivel - Netherlands Institute for Health Services Research, PO Box 1568, 3500BN, 
      Utrecht, The Netherlands. p.groenewegen@nivel.nl.
FAU - Spreeuwenberg, Peter
AU  - Spreeuwenberg P
AD  - Nivel - Netherlands Institute for Health Services Research, PO Box 1568, 3500BN, 
      Utrecht, The Netherlands.
FAU - Leyland, Alastair H
AU  - Leyland AH
AD  - MRC/CSO Social and Public Health Sciences Unit, Clarice Pears Building 90 Byres 
      Road, Glasgow, G12 8TB, UK.
FAU - de Boer, Dolf
AU  - de Boer D
AD  - Nivel - Netherlands Institute for Health Services Research, PO Box 1568, 3500BN, 
      Utrecht, The Netherlands.
FAU - Boerma, Wienke
AU  - Boerma W
AD  - Nivel - Netherlands Institute for Health Services Research, PO Box 1568, 3500BN, 
      Utrecht, The Netherlands.
LA  - eng
GR  - MC_UU_0022/2/MRC_/Medical Research Council/United Kingdom
PT  - Journal Article
DEP - 20231204
PL  - Germany
TA  - J Patient Rep Outcomes
JT  - Journal of patient-reported outcomes
JID - 101722688
SB  - IM
MH  - Humans
MH  - *General Practitioners
MH  - Risk Adjustment
MH  - Minimal Clinically Important Difference
MH  - Patient Reported Outcome Measures
MH  - Primary Health Care
PMC - PMC10695892
OTO - NOTNLM
OT  - Case-mix
OT  - International comparison
OT  - Multilevel analysis
OT  - PREMs
OT  - PROMs
OT  - Primary care
COIS- The authors declare that they have no competing interests.
EDAT- 2023/12/04 12:42
MHDA- 2023/12/05 12:43
PMCR- 2023/12/04
CRDT- 2023/12/04 11:11
PHST- 2023/06/07 00:00 [received]
PHST- 2023/11/26 00:00 [accepted]
PHST- 2023/12/05 12:43 [medline]
PHST- 2023/12/04 12:42 [pubmed]
PHST- 2023/12/04 11:11 [entrez]
PHST- 2023/12/04 00:00 [pmc-release]
AID - 10.1186/s41687-023-00667-8 [pii]
AID - 667 [pii]
AID - 10.1186/s41687-023-00667-8 [doi]
PST - epublish
SO  - J Patient Rep Outcomes. 2023 Dec 4;7(1):127. doi: 10.1186/s41687-023-00667-8.