Beyond the ecological fallacy: potential problems when studying healthcare organisations

Journal of the Royal Society of Medicine

Volumn 109, Issue 3, 2016, Pages 92-97

  Saunders, Catherine L ^a,b   Elliott, Marc N ^b   Lyratzopoulos, Georgios ^a,c   Abel, Gary A ^a  

^a UNIVERSITY OF CAMBRIDGE   (United Kingdom)

^b RAND CORPORATION   (United States)

^c UNIVERSITY COLLEGE LONDON   (United Kingdom)

Author keywords

[No Author keywords available]

Indexed keywords

ACCESS TO INFORMATION; ARTICLE; CORRELATION COEFFICIENT; ECOLOGICAL FALLACY; EFFECT SIZE; HEALTH CARE ORGANIZATION; HEALTH CARE QUALITY; HUMAN; MEASUREMENT ERROR; PUBLISHING; RELIABILITY; SAMPLE SIZE; STATISTICAL ANALYSIS; VARIANCE; HEALTH CARE DELIVERY; HEALTH SERVICE; HEALTH SERVICES RESEARCH; HOSPITAL; METHODOLOGY; STANDARDS; STATISTICAL BIAS;

BIAS (EPIDEMIOLOGY); DELIVERY OF HEALTH CARE; HEALTH SERVICES; HEALTH SERVICES RESEARCH; HOSPITALS; HUMANS; RESEARCH DESIGN;

EID: 84961246614     PISSN: 01410768     EISSN: 17581095     Source Type: Journal    
DOI: 10.1177/0141076815610574     Document Type: Article

References (20)

1. E.S.FisherJ.E.WennbergT.A.StukelJ.S.SkinnerS.M.SharpJ.L.Freeman. Associations among hospital capacity, utilization, and mortality of US Medicare beneficiaries, controlling for sociodemographic factors. Health Serv Res2000; 34(6): 1351–1362.
2. F.GreavesA.A.LavertyC.Millett. Friends and family test results only moderately associated with conventional measures of hospital quality. BMJ2013; 347: f4986–f4986.
3. R.HeijinkX.KoolmanD.PieterA.van der VeenB.JarmanG.Westert. Measuring and explaining mortality in Dutch hospitals; the hospital standardized mortality rate between 2003 and 2005. BMC Health Serv Res2008; 8: 73–73.
4. W.G.LehrmanM.N.ElliottE.GoldsteinM.K.BeckettD.J.KleinL.A.Giordano. Characteristics of hospitals demonstrating superior performance in patient experience and clinical process measures of care. Med Care Res Rev2010; 67(1): 38–55.
5. N.R.LlanwarneG.A.AbelM.N.ElliottC.A.PaddisonG.LyratzopoulosJ.L.Campbell. Relationship between clinical quality and patient experience: analysis of data from the English Quality and Outcomes Framework and the National GP Patient Survey. Ann Fam Med2013; 11(5): 467–472.
6. N.BloomZ.CooperM.GaynorS.GibbonsS.JonesA.McGuire. In defence of our research on competition in England’s National Health Service. Lancet2011; 378(9809): 2064–2065.
7. A.PollockA.MacfarlaneG.KirkwoodF.A.MajeedI.GreenerC.Morelli. No evidence that patient choice in the NHS saves lives. Lancet2011; 378(9809): 2057–2060.
8. J.W.FinneyK.HumphreysD.R.KivlahanA.H.Harris. Why health care process performance measures can have different relationships to outcomes for patients and hospitals: understanding the ecological fallacy. Am J Pub Health2011; 101(9): 1635–1642.
9. R.Anhang PriceM.N.ElliottA.M.ZaslavskyR.D.HaysW.G.LehrmanL.Rybowski. Examining the role of patient experience surveys in measuring health care quality. Med Care Res Rev2014; 71(5): 522–554.
10. D.J.Spiegelhalter. Funnel plots for comparing institutional performance. Stat Med2005; 24(8): 1185–1202.
11. G.LyratzopoulosM.N.ElliottJ.M.BarbiereL.StaetskyC.A.PaddisonJ.Campbell. How can health care organizations be reliably compared? Lessons from a national survey of patient experience. Med Care2011; 49(8): 724–733.
12. M.N.ElliottA.M.ZaslavskyP.D.Cleary. Are finite population corrections appropriate when profiling institutions?Health Serv Outcomes Res Methodol2006; 6(304): 153–156.
13. P.M.Muchinsky. The correction for attenuation. Educ Psychol Measurement1996; 56(1): 63–75.
14. The Medicare Quality Compare Database. See www.medicare.gov/hospitalcompare/search.html (last checked 29 September 2015)
15. The Health and Social Care Information Centre Indicator Portal. See indicators.ic.nhs.uk/ (last checked 29 September 2015)
16. International Hospital Federation in the Netherlands. 94 acute care hospitals in the Netherlands. See www.ihf-fih.org (last checked 29 September 2015)
17. Mander AP. SAMPSI_RHO: Stata module to compute sample size for a Pearson correlation, 2006 (revised 12 April 2011)
18. Y.BenjaminiY.Hochberg. Controlling the false discovery rate – a practical and powerful approach to multiple testing. J R Stat Soc B1995; 57(1): 289–300.
19. J.P.Ioannidis. Why most published research findings are false. PLoS Med2005; 2(8): e124–e124.
20. S.G.NichollsP.QuachE.von ElmA.GuttmannD.MoherI.Petersen. The REporting of Studies Conducted Using Observational Routinely-Collected Health Data (RECORD) statement: methods for arriving at consensus and developing reporting guidelines. PLoS One2015; 10(5): e0125620–e0125620.