title: Detecting and visualizing outliers in provider profiling via funnel plots and mixed effect models.
abstract: In this work we propose the use of a graphical diagnostic tool (the funnel plot) to detect outliers among hospitals that treat patients affected by Acute Myocardial Infarction (AMI). We consider an application to data on AMI hospitalizations recorded in the administrative databases of our regional district. The outcome of interest is the in-hospital mortality, a variable indicating if the patient has been discharged dead or alive. We then compare the results obtained by graphical diagnostic tools with those arising from fitting parametric mixed effects models to the same data.
authors.affiliation: MOX - Modellistica e Calcolo Scientifico, Dipartimento di Matematica, Politecnico di Milano, via Bonardi 9, 20133, Milan, Italy, francesca.ieva@polimi.it.
authors.forename: Francesca
authors.initials: F
authors.lastname: Ieva
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Paganoni
mesh_terms: D016208:Databases, Factual; D017052:Hospital Mortality; D006801:Humans; D007558:Italy / Q000453:epidemiology; D015233:Models, Statistical; D009203:Myocardial Infarction / Q000401:mortality*; D010043:Outcome and Process Assessment, Health Care; D010351:Patient Discharge / Q000706:statistics & numerical data; D019984:Quality Indicators, Health Care