# Benchmarking & Clinician Profiles
# Assigned Reading
Use data balancing to benchmark clinicians (use instructor's last
name as password)
Read►
# Presentations
# Assignments
**Question 1:**
In the following question, use SQL to analyze the data. Assume that we have followed two clinicians, Smith
and Jones, and constructed the decision trees in Figure 1.
Data►
Atoosa's
Excel►
Pooja's Video►
SQL Code►
**Figure 1: Practice Patterns of Dr. Jones and Smith**
- What is the expected length of stay for each of the clinicians?
- What is the expected length of stay for Dr. Smith if he were to take care of
patients of Dr. Jones?
- What is the expected length of stay for Dr. Jones if he were to take of patients
of Dr. Smith?
**Question 2: **The following data report
patients with 10 Diagnostic Related Groups and 3 HCC indices cared for by a clinician and
his peer group. Use SQL to determine if the clinician is more efficient
than his peer group.
Data►
SQL►
**Question 3:** The following table shows the
observed and expected length of stay for 30 patients.
Use paired
comparison of means to test that the expected and observed length of stay are
the same. Assuming normal distribution of the length of stay, use risk-adjusted
control chart to plot the data. Make sure that control limits are derived
from the expected values and observations are contrasted to these
limits. This analysis can be done using Tukey or XmR and you
need to select which chart produces tighter control limits. The conclusions you arrive at based on (a) paired
comparison of expected and observed length of stay and (b) the
risk-adjusted control charts should be the same if in both situations we
were calculating the control limits from the same number of cases. Are they?
Data►
Answer►
**Question 4**: Use the procedure described for
outcomes in synthetic cases, to estimate mortality
rate for 80 year residents with walking and toileting
disabilities but no other disabilities. Note that we want to rely on
at least 30 cases in making this estiamte. In the database there are
not 30 cases with these two disabilities and 80 years of age.
Therefore, we would like you to estimate the survial days using synthetic
case outcomes. You can create a synthetic case from 80 year olds who
are unable to walk and residents who are unable to toilet.
Alternatively you can select a different set of residents, such as 80 year
olds who are unable to toilet and residents who are unable to walk.
Also note that the data do not have headers. Use the following
dictionay of variables to create a header for the data. Data►
Adel's Teach One►
**Order** |
**
Variable** |
**
Description** |
1 |
ID |
Resident's ID |
2 |
Age |
Age at first assessment |
3 |
Sex |
Gender of resident |
4 |
tAssess |
Number of assessments |
5 |
Followed |
Days resident followed |
6 |
DaysFirst |
Days from first assessment |
7 |
DaysLast |
Days to last assessment |
8 |
uEat |
Unable to eat |
9 |
uSit |
Unable to sit |
10 |
uGroom |
Unable to groom |
11 |
uToilet |
Unable to toilet |
12 |
uBathe |
Unable to bathe |
13 |
uWalk |
Unable to walk |
14 |
uDress |
Unable to dress |
15 |
uBowel |
Bowel incontinent |
16 |
uUrine |
Urine incontinent |
17 |
EverDead |
Patient dead at one point in time |
18 |
AssessID |
Assessment ID |
19 |
Dead6Months |
Dead within 6 months of assessment |
**Question 5:** The following data show the recovery from various
disabilities in two nursing homes. Two sets of data are presented.
The first set shows the disabilities of the patients at admission to the
nursing home, using variables that start with "u", standing for "unable".
The recovery from the disabilities is also shown in variables that start
with "r". Compare the performance of these two nursing homes using
distribution switch method. In particular, switch the distribution
for age, gender, and 9 disabilities on admission. The outcome
of interest is the number of disabilities recovered from (variable shown
as nRecovery). Use synthetic method to estimate outcome for cases not present in both nursing homes. Which nursing home has better
outcome for its own residents? What happens if residents at nursing
home A were cared for at nursing home B, which nursing home would have
better outcomes now? What will happen if the reverse happens? Data►
- Practice profiling PubMed►
- Importance of risk adjustment in measuring performance in primary care PubMed►
Prepared by
Farrokh
Alemi, Ph.D.
This page is part of the course on
Statistical
Process Improvement |