Different Approaches for Case-Mix Adjustment of Patient-Reported Outcomes to Compare Healthcare Providers-Methodological Results of a Systematic Review.

Nora Tabea Sibert,Christoph Kowalski,Holger Pfaff,Clara Breidenbach,Simone Wesselmann

doi:10.3390/cancers13163964

Abstract

Simple SummaryPatient-reported outcomes need to be reported with case-mix adjustment in order to allow fair comparison between healthcare providers. This systematic review identified different approaches to case-mix adjustment, with wide variation between the various approaches.Patient-reported outcomes (PROs) are increasingly being used to compare the quality of outcomes between different healthcare providers (medical practices, hospitals, rehabilitation facilities). However, such comparisons can only be fair if differences in the case-mix between different types of provider are taken into account. This can be achieved with adequate statistical case-mix adjustment (CMA). To date, there is a lack of overview studies on current CMA methods for PROs. The aim of this study was to investigate which approaches are currently used to report and examine PROs for case-mix-adjusted comparison between providers. A systematic MEDLINE literature search was conducted (February 2021). The results were examined by two reviewers. Articles were included if they compared (a) different healthcare providers using (b) case-mix-adjusted (c) patient-reported outcomes (all AND conditions). From 640 hits obtained, 11 articles were included in the analysis. A wide variety of patient characteristics were used as adjustors, and baseline PRO scores and basic sociodemographic and clinical information were included in all models. Overall, the adjustment models used vary considerably. This evaluation is an initial attempt to systematically investigate different CMA approaches for PROs. As a standardized approach has not yet been established, we suggest creating a consensus-based methodological guideline for case-mix adjustment of PROs.

Highlights

There is a growing body of evidence that patient-reported outcomes (PROs) are effective in improving cancer patients’ health when used for patient monitoring or as a tool during patient consultations for better evaluation of patients’ symptoms or functional impairment [1,2,3,4]
In addition to these approaches based on individual patients, PROs can be used for another purpose in routine clinical care—quality assurance—in the sense of quality improvement initiatives
PROs are regarded in a similar manner as other quality metrics: if suboptimal outcomes are observed at the provider level, the providers are typically asked to use these comparisons as part of their quality management in order to improve care

Summary

Introduction

There is a growing body of evidence that patient-reported outcomes (PROs) are effective in improving cancer patients’ health when used for patient monitoring or as a tool during patient consultations for better evaluation of patients’ symptoms or functional impairment [1,2,3,4]. Due to cost and organizational barriers [10], only a small proportion of patients are currently benefiting from these approaches, but PROs are on the wish list of many service providers and healthcare systems and can be expected to find their way into more and more national cancer plans in the near future [11] In addition to these approaches based on individual patients, PROs can be used for another purpose in routine clinical care—quality assurance—in the sense of quality improvement initiatives. Building on the ICHOM standard dataset for localized prostate cancer [12], for example, the multinational TrueNorth Global Registry has been set up [13], with over 200 participating sites in 15 countries and with national substudies, e.g., [14] It has been argued in the past that these two functions (with approaches at the individual patient level and at the provider level) can work hand in hand, but examples of this are as yet scarce [15]

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