title: Combined quality improvement ratio: a method for a more robust evaluation of changes in screening rates.
abstract: BACKGROUND
  It has been proposed that a ratio of the discordant cells from a McNemar's Chi-square table be used as a measure of quality improvement, and that this measure be called the Quality Improvement Ratio (QuIR). As proposed, patients enrolled in only one year of a two-year study are excluded from the McNemar's table of the QuIR. Since the original proposal of the McNemar's Chi-square in 1947 included application to matched pair data, a more comprehensive analysis would be possible if the single-year enrollees were matched into pairs.
  
  
  METHODS
  Patients enrolled in only the first study year are matched and paired with patients enrolled in only the second study year. The pairs are matched on variables important to the disease or process being evaluated. The matched pairs are combined with the repeatedly measured subjects to increase the statistical power of the analysis. The Combined Quality Improvement Ratio (CQuIR) is demonstrated with parameters from the original articles, in a--Markov chain Monte-Carlo simulation, so a direct comparison can be made.
  
  
  RESULTS
  CQuIR improved statistical power, especially in simulations of small populations. In some simulations the statistical power was double that of the QuIR alone.
  
  
  CONCLUSIONS
  Although the QuIR provides important information, the CQuIR allows more of the data to be used to evaluate the effect of interventions in policy, delivery, and practice. The increase in statistical power of the CQuIR over the QuIR can facilitate successful evaluation of health care services.
authors.affiliation: Outcomes Assessment Department, Division of Research, Alton Ochsner Medical Foundation, New Orleans, 1516 Jefferson Highway, New Orleans, LA 7021, USA. rchambers@ochsner.org
authors.forename: R B
authors.initials: RB
authors.lastname: Chambers
authors.forename: M A
authors.initials: MA
authors.lastname: Krousel-Wood
authors.forename: R
authors.initials: R
authors.lastname: Re
mesh_terms: D001943:Breast Neoplasms / Q000517:prevention & control; D016009:Chi-Square Distribution; D005260:Female; D006302:Health Services Research / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D008327:Mammography / Q000706:statistics & numerical data; D008390:Markov Chains; D008403:Mass Screening / Q000706:statistics & numerical data*; D017749:Total Quality Management / Q000706:statistics & numerical data*; D014481:United States