Albuminuria measurement in diabetic care: a multilevel analysis measuring the influence of accreditation on institutional performance
Background Studies assessing institutional performance regarding quality of care are frequently performed using single-level statistical analyses investigating differences between provider averages of various quality indicators. However, such analyses are insufficient as they do not consider patient...
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BMJ Publishing Group
2019-01-01
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| Series: | BMJ Open Quality |
| Online Access: | https://bmjopenquality.bmj.com/content/8/1/e000449.full |
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| author | Nermin Ghith Juan Merlo Anne Frølich |
| author_facet | Nermin Ghith Juan Merlo Anne Frølich |
| author_sort | Nermin Ghith |
| collection | DOAJ |
| description | Background Studies assessing institutional performance regarding quality of care are frequently performed using single-level statistical analyses investigating differences between provider averages of various quality indicators. However, such analyses are insufficient as they do not consider patients’ heterogeneity around those averages. Hence, we apply a multilevel analysis of individual-patient heterogeneity that distinguishes between ‘general’ (‘latent quality’ or measures of variance) and ‘specific’ (measures of association) contextual effects. We assess general contextual effects of the hospital departments and the specific contextual effect of a national accreditation programme on adherence to the standard benchmark for albuminuria measurement in Danish patients with diabetes.Methods From the Danish Adult Diabetes Database, we extracted data on 137 893 patient cases admitted to hospitals between 2010 and 2013. Applying multilevel logistic and probit regression models for every year, we quantified general contextual effects of hospital department by the intraclass correlation coefficient (ICC) and the area under the receiver operating characteristic curve (AUC) values. We evaluated the specific effect of hospital accreditation using the ORs and the change in the department variance.Results In 2010, the department context had considerable influence on adherence with albuminuria measurement (ICC=21.8%, AUC=0.770), but the general effect attenuated along with the implementation of the national accreditation programme. The ICC value was 16.5% in 2013 and the rate of compliance with albuminuria measurement increased from 91.6% in 2010 to 96% in 2013.Conclusions Parallel to implementation of the national accreditation programme, departments’ compliance with the standard benchmark for albuminuria measurement increased and the ICC values decreased, but remained high. While those results indicate an overall quality improvement, further intervention focusing on departments with the lowest compliance could be considered. |
| format | Article |
| id | doaj-art-1b26443d812640fea083c32ba51dd7a1 |
| institution | Kabale University |
| issn | 2399-6641 |
| language | English |
| publishDate | 2019-01-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Quality |
| spelling | doaj-art-1b26443d812640fea083c32ba51dd7a12024-11-27T04:00:08ZengBMJ Publishing GroupBMJ Open Quality2399-66412019-01-018110.1136/bmjoq-2018-000449Albuminuria measurement in diabetic care: a multilevel analysis measuring the influence of accreditation on institutional performanceNermin Ghith0Juan Merlo1Anne Frølich2Research Unit of Chronic Conditions, Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg University Hospital, Frederiksberg, Denmark1 Unit for Social Epidemiology, Department of Clinical Sciences, Lund University, Lund, Sweden9 Innovation and Research Centre for Multimorbidity, Slagelse Hospital, Slagelse, DenmarkBackground Studies assessing institutional performance regarding quality of care are frequently performed using single-level statistical analyses investigating differences between provider averages of various quality indicators. However, such analyses are insufficient as they do not consider patients’ heterogeneity around those averages. Hence, we apply a multilevel analysis of individual-patient heterogeneity that distinguishes between ‘general’ (‘latent quality’ or measures of variance) and ‘specific’ (measures of association) contextual effects. We assess general contextual effects of the hospital departments and the specific contextual effect of a national accreditation programme on adherence to the standard benchmark for albuminuria measurement in Danish patients with diabetes.Methods From the Danish Adult Diabetes Database, we extracted data on 137 893 patient cases admitted to hospitals between 2010 and 2013. Applying multilevel logistic and probit regression models for every year, we quantified general contextual effects of hospital department by the intraclass correlation coefficient (ICC) and the area under the receiver operating characteristic curve (AUC) values. We evaluated the specific effect of hospital accreditation using the ORs and the change in the department variance.Results In 2010, the department context had considerable influence on adherence with albuminuria measurement (ICC=21.8%, AUC=0.770), but the general effect attenuated along with the implementation of the national accreditation programme. The ICC value was 16.5% in 2013 and the rate of compliance with albuminuria measurement increased from 91.6% in 2010 to 96% in 2013.Conclusions Parallel to implementation of the national accreditation programme, departments’ compliance with the standard benchmark for albuminuria measurement increased and the ICC values decreased, but remained high. While those results indicate an overall quality improvement, further intervention focusing on departments with the lowest compliance could be considered.https://bmjopenquality.bmj.com/content/8/1/e000449.full |
| spellingShingle | Nermin Ghith Juan Merlo Anne Frølich Albuminuria measurement in diabetic care: a multilevel analysis measuring the influence of accreditation on institutional performance BMJ Open Quality |
| title | Albuminuria measurement in diabetic care: a multilevel analysis measuring the influence of accreditation on institutional performance |
| title_full | Albuminuria measurement in diabetic care: a multilevel analysis measuring the influence of accreditation on institutional performance |
| title_fullStr | Albuminuria measurement in diabetic care: a multilevel analysis measuring the influence of accreditation on institutional performance |
| title_full_unstemmed | Albuminuria measurement in diabetic care: a multilevel analysis measuring the influence of accreditation on institutional performance |
| title_short | Albuminuria measurement in diabetic care: a multilevel analysis measuring the influence of accreditation on institutional performance |
| title_sort | albuminuria measurement in diabetic care a multilevel analysis measuring the influence of accreditation on institutional performance |
| url | https://bmjopenquality.bmj.com/content/8/1/e000449.full |
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