HEALTHCARE METRICS

About Metrics
Metric is derived from the word measure. Whatever metric you decide to use will depend on the process and whether data can be obtained at steps within that process Metric should be meaningful and representative enough to judge work, effort, quality, timeliness, and satisfaction.

Metrics
Healthcare metrics are usually in the form of time, count, proportion, costs and evaluation. Although metrics are made for a number of reasons including control, improvement and compliance, we will focus on improvement.

Example Metrics
Time

Length of stay days

Time in waiting rooms hours

Time to process a claim

Time spent assembling patients charts

Example Metrics
Count (Total or Average) Number of readmits Number left without being seen Number of patients with incomplete lab slips Number of patients contacted

Number of errors occurring in a procedure Comparative count data

Example Metrics
Proportion % Complications % Readmits % Understaffed

Costs
Cost per case or patient Total costs of procedures Total cost of salaries Savings per case

Example Metrics
Evaluation Customer surveys

Customer complaints

Metrics Measuring Improvement

Improvement, as measured with data, is based on comparing for differences in the averages of populations or differences from some standard or target.
And on comparing for statistical differences in variation dispersion (distribution) about means.

Metrics Parametric vs Nonparametric Analysis

Tests for differences in averages are either parametric or nonparametric. Parametric tests are considered more powerful in measuring differences in means and can be used to measure differences in the amount of dispersion. Nonparametric tests can be used to compare non-normal distributions.

Parametric (Normal) Distribution

100 %

95 %

68 %

-3

-2

-1

+1

+2

+3

Metrics Parametric Restrictions for Differences in Means

The data must be approximately normally distributed. The variances (measures of normal variation) must be equivalent, at least to an acceptable degree.

Note: Parametric testing is more restrictive than the non-normal counterpart.

Metrics About Nonparametric Tests

Nonparametric tests are suitable for comparing data from non-normal distributions. Nonparametric tests rank the data by order of magnitude and compare the medians rather than the means. Small samples from suspected non-normal population distributions can be compared by nonparametric testing.

AMI Length of Stay

Stddev 5.21 34.00 Max 1.00 Min

60.00

5.25 Mean Median 4.00

Mode

2.00

50.00

Nonparametric

40.00
Number of Patents

30.00

20.00

10.00

0.00
1.00 2.00 3.00 4.00 5.00 6.00 7.00 8.00 9.00 10.00 11.00 12.00 13.00 14.00 15 16 20 21 23 25 29 33 34

Length of Stay - Days

Metrics Frequencies
Chi-square tests for analyzing frequencies are very useful for things that are counted and classified on nominal scales (categories) such as sex, age-group, blood group type, ethnic origin and so on. Tests commonly used are:
1. Test for Homogeneity 2. Goodness of fit 3. Test of association Contingency tables

Metrics Sample Size

The larger the sample size, the smaller the differences in averages that can be detected. Often, the amount of difference in averages that is desired to be detected is balanced against the size of the sample required for this detection and the amount of error that can be tolerated for this detection.

Metrics Sample Size

However, very small differences in averages can result in large savings in costs, thus making large samples necessary. On the other hand, there are diminishing returns as the sample size becomes larger and larger.