Addressing Missing Data in Patient-Reported Outcome Measures (PROMS): Implications for the Use of PROMS for Comparing Provider Performance.
Patient-reported outcome measures (PROMs) are now routinely collected in the English National Health Service and used to compare and reward hospital performance within a high-powered pay-for-performance scheme. However, PROMs are prone to missing data. For example, hospitals often fail to administer the pre-operative questionnaire at hospital admission, or patients may refuse to participate or fail to return their post-operative questionnaire. A key concern with missing PROMs is that the individuals with complete information tend to be an unrepresentative sample of patients within each provider and inferences based on the complete cases will be misleading. This study proposes a strategy for addressing missing data in the English PROM survey using multiple imputation techniques and investigates its impact on assessing provider performance. We find that inferences about relative provider performance are sensitive to the assumptions made about the reasons for the missing data.
Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.
Manuel
M
Gomes
Centre for Health Economics, University of York, York, UK.
Nils
N
Gutacker
Centre for Health Economics, University of York, York, UK.
Chris
C
Bojke
Centre for Health Economics, University of York, York, UK.
Andrew
A
Street
D000465:Algorithms; D003625:Data Collection / Q000379:methods*; D004739:England; D006761:Hospitals; D006801:Humans; D000071066:Patient Reported Outcome Measures; D019984:Quality Indicators, Health Care; D012052:Reimbursement, Incentive; D013222:State Medicine / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires
missing data; missing not at random; multiple imputation; patient-reported outcome measures; provider performance