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Abstract：
Healthcare quality measures are statistics that serve to evaluate healthcare providers and identify those that need to improve their care. Before using these measures in clinical practice, developers and reviewers assess measure reliability, which describes the degree to which differences in the measure values reflect actual variation in healthcare quality, as opposed to random noise. The Inter-Unit Reliability (IUR) is a popular statistic for assessing reliability, and it describes the proportion of total variation in a measure that is attributable to between-provider variation. However, Kalbfleisch, He, Xia, and Li (2018) [Health Services and Outcomes Research Methodology, 18, 215-225] have argued that the IUR has a severe limitation in that some of the between-provider variation may be unrelated to quality of care. In this paper, we illustrate the practical implications of this limitation through several concrete examples. We show that certain best-practices in measure development, such as careful risk adjustment and exclusion of unstable measure values, can decrease the sample IUR value. These findings uncover potential negative consequences of discarding measures with IUR values below some arbitrary threshold.
摘要：
医疗保健质量措施是用于评估医疗保健提供者并确定需要改善其护理的统计数据。在临床实践中使用这些措施之前，开发人员和审稿人评估测量可靠性，它描述了测量值的差异反映了医疗保健质量的实际变化的程度，而不是随机噪声。单位间可靠性(IUR)是评估可靠性的流行统计数据，它描述了可归因于提供者之间差异的度量中总差异的比例。然而,Kalbfleisch,他,夏，和李（2018）[卫生服务与结果研究方法，18，215-225]认为IUR具有严重的局限性，因为提供者之间的某些差异可能与护理质量无关。在本文中,我们通过几个具体的例子说明了这种限制的实际意义。我们展示了度量开发中的某些最佳实践，例如仔细调整风险和排除不稳定的度量值，可以降低样品IUR值。这些发现揭示了丢弃IUR值低于某个任意阈值的措施的潜在负面影响。
