Statistical methods for healthcare regulation: rating, screening and surveillance

Current demand for accountability and efficiency of healthcare organizations, combined with the greater availability of routine data on clinical care and outcomes, has led to an increased focus on statistical methods in healthcare regulation. We consider three different regulatory functions in which statistical analysis plays a vital role: rating organizations, deciding whom to inspect and continuous surveillance for arising problems. A common approach to data standardization based on (possibly overdispersed) Z-scores is proposed, although specific tools are used for assessing performance against a target, combining indicators when screening for inspection, and continuous monitoring using risk-adjusted sequential testing procedures. We pay particular attention to the problem of simultaneously monitoring over 200000 indicators for excess mortality, both with respect to the statistical issues surrounding massive multiplicity, and the organizational aspects of dealing with such a complex but high profile process.