Technical Review Number 10

Strategies To Support Quality-based Purchasing: A Review of the Evidence

File Inventory


Prepared by:

Stanford-University of California San Francisco Evidence-based Practice Center

Principal Investigator
   R. Adams Dudley, M.D., M.B.A.

Investigators
   Anne Frolich, M.D.
   David L. Robinowitz, M.D.
   Jason A. Talavera, B.S.
   Peter Broadhead, B.A.
   Harold S. Luft, Ph.D.

Other Contributor
   Kathryn McDonald, M.M.
   EPC Associate Director


File Name	Description			Software	Version	File	Size
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01front.doc	Microsoft Word® Document	MS Word®	2002	68KB	10 pages
Contents: Title Page, Preface, Acknowledgments, Structured Abstract, Table of Contents
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02chap1.doc	Microsoft Word® Document	MS Word®	2002	868KB	14 pages
Contents: Chapter 1. Introduction: Background, Purpose of This Report, Rationale for Focus 
on Randomized Controlled Trials, Types of Incentives, Incentive Theory, Figure 1. Application 
of Andersen's model to provider behavior, Characteristics of Incentives, Conceptual Models 
of Individual Provider and Organizational Responses to Incentives, Figure 2. Model of an 
individual provider's response to incentives, Figure 3. Model of an organization's response 
to incentives
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03chap2.doc	Microsoft Word® Document	MS Word®	2002	134KB	8 pages
Contents: Chapter 2. Methods for Literature Search: Technical Expert Advisory Panel, 
Target Audiences and Population, Key Questions, Literature Review Methods, Table 1. Information 
sources for literature review and catalog of ongoing research, Table 2. MEDLINE® searches to 
identify potentially relevant primary data, Table 3. Search terms and citations for Cochrane 
databases, Table 4. Evaluating randomized controlled trials for completeness of reporting, 
Identifying Ongoing Research, Table 5. Information sources for the catalog of ongoing research, 
Table 6. Search terms and citations for GOLD, Table 7. Search terms and citations for HSRProj 
database, Table 8. Design information sought about ongoing research, 
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04chap3.doc	Microsoft Word® Document	MS Word®	2002	875KB	14 pages
Contents: Chapter 3. Results for Literature Search: Synthesis of Literature About Quality-based 
Purchasing; Figure 4. Articles identified by systematic searches; Table 9. Evaluating randomized, 
controlled trials for completeness of reporting; Table 10. Available results by conceptual model 
domains tested; Ongoing Research Into Quality-based Purchasing
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05t11t12.doc	Microsoft Word® Document	MS Word®	2002	72KB	4 pages
Contents: Chapter 3 (continued): Table 11. Ongoing quality-baased purchasing research: Projects 
in the Rewarding Results initiative; Table 12. Ongoing quality-based purchasing research: 
Other QBP projects
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06chap4.doc	Microsoft Word® Document	MS Word®	2002	103KB	7 pages
Contents: Chapter 4. Methods for Assessing the Usefulness of Outcome Reports: General 
Approach to Simulation; Figure 5. Hypothetical world of hospitals; Figure 6. Hypothetical 
world and evaluation function (adapted from Thomas and Hofer); Enhancements to the Thomas 
and Hofer Model; Table 13. The six scenarios simulated
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07chap5.doc	Microsoft Word® Document	MS Word®	2002	230KB	16 pages
Contents: Chapter 5. Results of Simulations To Assess the Usefulness of Outcomes Reports: 
Scenario 1: Reproducing Thomas and Hofer; Table 14. Scenario 1: Predictive values, year 1; 
Table 15. Scenario 1, year 1: Sensitivity and specificity calculations; Table 16. Scenario 
1: Probability, given that a hospital has received two, three, or four stars over 2 years, 
that it is good vs. poor; Table 17. Scenario 1: Expected score distribution over 2 years; 
Figure 7. Scenario 1: Percentage of good vs. bad hospitals by 3-year star score; Table 18. 
Scenario 1: Expected score distribution for good vs. poor hospitals over 3 years; 
Scenario 2: Adding Another Hospital Category; Figure 8. Scenario 2: Hypothetical world of 
hospitals; Figure 9. Scenario 2: Hypothetical world and evaluation function; Figure 10. 
Scenario 2: Proportion of superior, good, and poor hospitals by 3-year star score; Figure 
11. Scenario 2: Proportion of poor, good, and superior hospitals with each type of derivative 
score; Scenario 3: Updating Assumptions About the Hypothetical Distribution of Hospital 
Quality; Figure 12. Scenario 3: The hypothetical world; Figure 13. Scenario 3: Hypothetical 
world and evaluation function; Figure 14. Scenario 3: Proportion of superior, good, and poor 
hospitals by 2-year star scores; Figure 15. Scenario 3, year 3: Proportion of superior, good, 
and poor hospitals by 3-year star score; Figure 16. Scenario 3: Three-year derivative scores, 
predictive values; Figure 17. Scenario 3: Distribution of 3-year derivative scores, predictive 
values; Scenario 4: Fewer Patients per Hospital (N = 100); Figure 18. Scenario 4: Hypothetical 
world and evaluation function; Figure 19. Scenario 4, year 3: Proportion of superior, good, 
and poor hospitals by 3-year star score; Scenario 5: Identifying a Higher Proportion of 
Outliers; Figure 20. Scenario 5: Hypothetical world and evaluation function; Figure 21. 
Scenario 5: Proportion of superior, good, and poor hospitals by 3-year star score; Scenario 
6: More Patients per Hospital
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08chap6.doc	Microsoft Word® Document	MS Word®	2002	80KB	12 pages
Contents: Chapter 6. Discussion: Analysis of Published and Ongoing Research; Evaluating 
Outcomes Reports; Future Research; Conclusion
References and Included Studies
Acronyms and Abbreviations
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09appa.doc	Microsoft Word® Document	MS Word®	2002	27KB	1 page
Contents: Appendix A. Quality-based Purchasing Technical Expert Panel and Peer Reviewers
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10appb.doc	Microsoft Word® Document	MS Word®	2002	26KB	2 pages
Contents: Appendix B. General Approach to Simulations
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11appc.doc	Microsoft Word® Document	MS Word®	2002	365KB	28 pages
Contents: Appendix C. Assessing the Usefulness of Outcome Reports: Methods for Simulations; 
Figure C1. Hypothetical World of Hospitals; Figure C2. Hypothetical World and Evaluation 
Function (adapted from Thomas and Hofer); Table C1. The Six Scenarios Simulated; Results of 
Simulations; Table C2. Scenario 1: Predictive Values, Year 1; Table C3. Scenario 1, Year 1: 
Sensitivity and Specificity Calculations; Table C4. Scenario 1: Probability, Given that a 
Hospital Has Received Two, Three, or Four Stars over 2 Years, that It is Good vs. Poor; 
Table C5. Scenario 1: Expected Score Distribution over 2 Years; Figure C3. Scenario 1: 
Percentage of Good vs. Bad Hospitals by 3-Year Star Score; Table C6. Scenario 1: Expected 
Score Distribution for Good vs. Poor Hospitals over 3 Years; Figure C4. Scenario 1: 
Expected 3-Year Score Distribution for Good vs. Poor Hospitals; Figure C5. Scenario 2: 
Hypothetical World; Figure C6. Scenario 2: Hypothetical World and Evaluation Function; 
Figure C7. Scenario 2: Proportion of Superior, Good, and Poor Hospitals by 2-Year Star Score; 
Figure C8. Scenario 2: Proportion of Superior, Good, and Poor Hospitals by 3-Year Star Score; 
Figure C9: Scenario 2: Proportion of Poor, Good, and Superior Hospitals with Each Type of 
Derivative Score; Figure C10. Scenario 2: Expected Distribution of 3-Year Star Scores by 
Hospital Type; Figure C11. Scenario 3: Hypothetical World; Figure C12: Scenario 3: 
Hypothetical World and Evaluation Function; Figure C13. Scenario 3: Proportion of Superior, 
Good, and Poor Hospitals by 2-Year Star Scores; Figure C14. Scenario 3: Proportion of 
Superior, Good, and Poor Hospitals by 3-Year Star Score; Figure C15. Scenario 3: Three-Year 
Derivative Scores, Predictive Values; Figure C16: Scenario 3: Expected Distribution of 
3-year Star Scores by Hospital Type; Figure C17. Scenario 3: Expected Distribution of 3-Year 
Star Scores by Hospital Type; Figure C18. Scenario 3: In 3 Years Ever Graded Poor vs. Never 
Graded Poor; Figure C19. Scenario 4: Hypothetical World and Evaluation Function; Figure C20.
Scenario 4: Proportion of Superior, Good, and Poor Hospitals by 3-Year Star Score; Figure 
C21. Scenario 4: Expected Distribution of 3-Year Star Scores by Hospital Type; Figure C22. 
Scenario 5: Hypothetical World and Evaluation Function; Figure C23. Scenario 5: Proportion 
of Superior, Good, and Poor Hospitals by 3-Year Star Score; Figure C24. Scenario 5: Three-Year 
Derivative Scores, Predictive Values; Figure C25. Scenario 5: Expected Distribution of 3-Year 
Star Scores by Hospital Type; Figure C26. Scenario 6: Proportion of Superior, Good, and Poor 
Hospital by 3-Year Star Score; Figure C27: Scenario 6: Three-Year Derivative Score Predictive 
Values; Figure C28. Scenario 6: Expected Distribution of 3-Year Star Scores by Hospital Type; 
References
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AHRQ Publication No. 04-0057
Current as of July 2004


Internet Citation:

Strategies To Support Quality-based Purchasing: A Review of the Evidence. File Inventory, Technical Review Number 10. AHRQ Publication No. 04-0057, July 2004. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/qbpurinv.htm


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