Anders Anell
Professor
A randomized comparison between league tables and funnel plots as an aid to health care decision-making
Author
Summary, in English
Objective Comparison of provider performance is commonly used to inform health care decision-making. Little attention has been paid to how data presentations influence decisions. This study analyzes differences in suggested actions by decision-makers informed by league tables or funnel plots.
Design Decision-makers were invited to a survey and randomized to compare hospital performance using either league tables or funnel plots for four different measures within the area of cancer care. For each measure, decision-makers were asked to suggest actions towards 12–16 hospitals (no action, ask for more information, intervene) and provide feedback related to whether the information provided had been useful.
Setting Swedish health care.
Participants Two hundred and twenty-one decision-makers at administrative and clinical levels.
Intervention Data presentations in the form of league tables or funnel plots.
Main outcome measures Number of actions suggested by participants. Proportion of appropriate actions.
Results For all four measures, decision-makers tended to suggest more actions based on the information provided in league tables compared to funnel plots (44% vs. 21%, P < 0.001). Actions were on average more appropriate for funnel plots. However, when using funnel plots, decision-makers more often missed to react even when appropriate.
Conclusions The form of data presentation had an influence on decision-making. With league tables, decision-makers tended to suggest more actions compared to funnel plots. A difference in sensitivity and specificity conditioned by the form of presentation could also be identified, with different implications depending on the purpose of comparisons. Explanations and visualization aids are needed to support appropriate actions.
Design Decision-makers were invited to a survey and randomized to compare hospital performance using either league tables or funnel plots for four different measures within the area of cancer care. For each measure, decision-makers were asked to suggest actions towards 12–16 hospitals (no action, ask for more information, intervene) and provide feedback related to whether the information provided had been useful.
Setting Swedish health care.
Participants Two hundred and twenty-one decision-makers at administrative and clinical levels.
Intervention Data presentations in the form of league tables or funnel plots.
Main outcome measures Number of actions suggested by participants. Proportion of appropriate actions.
Results For all four measures, decision-makers tended to suggest more actions based on the information provided in league tables compared to funnel plots (44% vs. 21%, P < 0.001). Actions were on average more appropriate for funnel plots. However, when using funnel plots, decision-makers more often missed to react even when appropriate.
Conclusions The form of data presentation had an influence on decision-making. With league tables, decision-makers tended to suggest more actions compared to funnel plots. A difference in sensitivity and specificity conditioned by the form of presentation could also be identified, with different implications depending on the purpose of comparisons. Explanations and visualization aids are needed to support appropriate actions.
Department/s
- Department of Business Administration
- Urology - urothelial cancer, Malmö
- BioCARE: Biomarkers in Cancer Medicine improving Health Care, Education and Innovation
- Breastcancer-genetics
Publishing year
2017-02-01
Language
English
Pages
816-823
Publication/Series
International Journal for Quality in Health Care
Volume
28
Issue
6
Document type
Journal article
Publisher
Oxford University Press
Topic
- Health Care Service and Management, Health Policy and Services and Health Economy
Keywords
- quality measurement
- quality management
- experimental research
- general methodology
- audit
- external quality assessment
Status
Published
Project
- Public Management Research
Research group
- Urology - urothelial cancer, Malmö
ISBN/ISSN/Other
- ISSN: 1464-3677