Analysis of hospital quality monitors using hierarchical time series models

Abstract

The VA management services department invests considerably in the collection and assessment of data to inform on hospital and care-area specific levels of quality of care. Resulting time series of quality monitors, provide information relevant to evaluating patterns of variability in hospital-specific quality of care over time and across care areas, and to compare and assess differences across hospitals. In collaboration with the VA management services group we have developed various models for evaluating such patterns of dependencies and combining data across the VA hospital system. This paper provides a brief overview of resulting models, some summary examples on three monitor time series, and discussion of data, modelling and inference issues. This work introduces new models for multivariate non-Gaussian time series. The framework combines cross-sectional, hierarchical models of the population of hospitals with time series structure to allow and measure time-variations in the associated hierarchical model parameters. In the VA study, the within-year components of the models describe patterns of heterogeneity across the population of hospitals and relationships among several such monitors, while the time series components describe patterns of variability through time in hospital-specific effects and their relationships across quality monitors. Additional model components isolate unpredictable aspects of variability in quality monitor outcomes, by hospital and care areas. We discuss model assessment, residual analysis and MCMC algorithms developed to fit these models, which will be of interest in related applications in other socio-economic areas.