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744 andrew gelman stats-2011-06-03-Statistical methods for healthcare regulation: rating, screening and surveillance


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Introduction: Here is my discussion of a recent article by David Spiegelhalter, Christopher Sherlaw-Johnson, Martin Bardsley, Ian Blunt, Christopher Wood and Olivia Grigg, that is scheduled to appear in the Journal of the Royal Statistical Society: I applaud the authors’ use of a mix of statistical methods to attack an important real-world problem. Policymakers need results right away, and I admire the authors’ ability and willingness to combine several different modeling and significance testing ideas for the purposes of rating and surveillance. That said, I am uncomfortable with the statistical ideas here, for three reasons. First, I feel that the proposed methods, centered as they are around data manipulation and corrections for uncertainty, has serious defects compared to a more model-based approach. My problem with methods based on p-values and z-scores–however they happen to be adjusted–is that they draw discussion toward error rates, sequential analysis, and other technical statistical


Summary: the most important sentenses genereted by tfidf model

sentIndex sentText sentNum sentScore

1 Policymakers need results right away, and I admire the authors’ ability and willingness to combine several different modeling and significance testing ideas for the purposes of rating and surveillance. [sent-2, score-0.248]

2 That said, I am uncomfortable with the statistical ideas here, for three reasons. [sent-3, score-0.125]

3 First, I feel that the proposed methods, centered as they are around data manipulation and corrections for uncertainty, has serious defects compared to a more model-based approach. [sent-4, score-0.171]

4 My problem with methods based on p-values and z-scores–however they happen to be adjusted–is that they draw discussion toward error rates, sequential analysis, and other technical statistical concepts. [sent-5, score-0.784]

5 In contrast, a model-based approach draws discussion toward the model and, from there, the process being modeled. [sent-6, score-0.35]

6 I understand the appeal of p-value adjustments–lots of quantitatively-trained people know about p-values–but I’d much rather draw the statistics toward the data rather than the other way around. [sent-7, score-0.469]

7 Once you have to bring out the funnel plot, this is to me a sign of (partial) failure, that you’re talking about properties of a statistical summary rather than about the underlying process that generates the observed data. [sent-8, score-0.517]

8 My second difficulty is closely related: to me, the mapping seems tenuous from statistical significance to the ultimate healthcare and financial goals. [sent-9, score-0.301]

9 That said, the authors of the article under discussion are doing the work and I’m not. [sent-11, score-0.253]

10 I’m sure they have good reasons for using what I consider to be inferior methods, and I believe that one of the points of this discussion is to give them a chance to give this explanation. [sent-12, score-0.133]

11 Finally, I am glad that these methods result in ratings rather than rankings . [sent-13, score-0.387]

12 (2002), and others, two huge problems arise when constructing ranks from noisy data. [sent-15, score-0.332]

13 First, with unbalanced data (for example, different sample sizes in different hospitals) there is no way to simultaneously get reasonable point estimates of parameters and their rankings. [sent-16, score-0.173]

14 Even with moderately large samples, estimated ranks are unstable and can be misleading, violating well-known principles of quality control by encouraging decision makers to chase noise rather than understanding and reducing variation (Deming, 2000). [sent-18, score-0.877]

15 Thus, although I am unhappy with the components of the methods being used here, I like some aspects of the output. [sent-19, score-0.189]

16 Uncertainty in rank estimation: Implications for Value Added Modeling Accountability Systems. [sent-32, score-0.078]


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