title: Hospital variation in patient-reported outcomes at the level of EQ-5D dimensions: evidence from England.
abstract: The English Department of Health has introduced routine collection of patient-reported outcome data for selected surgical procedures to facilitate patient choice and increase hospital accountability. However, using aggregate health outcome scores, such as EQ-5D utilities, for performance assessment purposes causes information loss and raises statistical and normative concerns.
  
  
  
  . For hip replacement surgery, we explore a) the change in patient-reported outcomes between baseline and follow-up on 5 health dimensions (EQ-5D), b) the extent to which treatment impact varies across hospitals, and c) the extent to which hospital performance on EQ-5D dimensions is correlated with performance on the EQ-5D utility index.
  
  
  
  . We combine information on pre- and postoperative EQ-5D outcomes with routine inpatient data for the financial year 2009-2010. The sample consists of 21,000 patients in 153 hospitals. We employ hierarchical ordered probit risk-adjustment models that recognize the multilevel nature of the data and the response distributions. The treatment impact is modeled as a random coefficient that varies at the hospital level. We obtain hospital-specific empirical Bayes (EB) estimates of this coefficient. We estimate separate models for each EQ-5D dimension and the EQ-5D utility index and analyze correlations of EB estimates across these.
  
  
  
  . Hospital treatment is associated with improvements in all EQ-5D dimensions. Variability in treatment impact is most pronounced on the mobility and usual activities dimensions. Conversely, only pain/discomfort and anxiety/depression correlate well with performance measures based on utilities. This leads to different assessments of hospital performance across metrics.
  
  
  
  . Our results indicate which hospitals are better than others in improving health across particular EQ-5D dimensions. We demonstrate the importance of evaluating dimensions of the EQ-5D separately for the purposes of hospital performance assessment.
authors: Centre for Health Economics, University of York, UK (NG, CB, SD, AS)
authors: Nils
authors: N
authors: Gutacker
authors: Centre for Health Economics, University of York, UK (NG, CB, SD, AS)
authors: Chris
authors: C
authors: Bojke
authors: Centre for Health Economics, University of York, UK (NG, CB, SD, AS)
authors: Silvio
authors: S
authors: Daidone
authors: Office of Health Economics, London, UK (ND)
authors: Nancy
authors: N
authors: Devlin
authors: Centre for Health Economics, University of York, UK (NG, CB, SD, AS)
authors: Andrew
authors: A
authors: Street
mesh_terms: D003625:Data Collection; D004739:England; D006779:Hospitals, Public; D006801:Humans; D008962:Models, Theoretical; D017063:Outcome Assessment, Health Care; D013222:State Medicine
keywords: EQ-5D; hierarchical ordered probit; patient-reported outcomes (PRO); performance assessment; provider profiling; quality measurement