Roy Carr-Hill wrote;
I think Harvey means 1996; and see my other note about the complexity
iof actiually getting the data in the first place.
Harvey Goldstein wrote:
>
> > Ray , interestingly, mentions the example which David Spiegelhalter
> > and I used in our 1966 JRSSA paper to highlight the real
> > difficulties of using medical league tables. What we showed was that
> > very little separation was apparent when uncertainty intervals were
> > calculated. The issue is how good these (adjusted) rankings are at
> > detecting real outliers. Their use as 'screening' devices could be
> > justified if used with care, but the danger is that, as in New York,
> > they come to be seen as objective judgements about individuals.
>
> Harvey Goldstein
>
> Ray's message follows.....................
>
> It looks as if one of the first new 'National Statistics' might be
> measures
> of performance of General Practioners!
> In the aftermath of the conviction for murder of Dr Shipman, one of
> the
> promises made by Alan Milburn the Minister of Health is to involve the
> ONS
> in monitoring the performance of GPs.
> I suppose it would be relatively easy to calculate the average
> expectation
> of life of patients of a particular doctor. The data needed is simply
> date
> of birth and date of death for all deaths. Is is not likely that, even
>
> though Shipman's victims were elderly, such calculations made on the
> basis
> of the deaths of his patients would have shown that something strange
> was
> going on?
> Standardised mortality rates for individual doctors, and individual
> practices, could also be calculated, but that would require data on
> the age
> distribution of all patients.
> This kind of monitoring is has some precedents in the US. New York
> State
> publishes statistics for the mortality rate for coronary artery bypass
>
> surgery for individual surgeons every year. See
> <http://www.health.state.ny.us>.
>
> Harvey Goldstein
> Institute of Education
> 20 Bedford Way
> London WC1H 0AL, U.K.
> Tel: +44 (0) 20 7612 6652
> Fax: +44 (0) 20 7612 6686
> [log in to unmask]
>
> Web sites:
> Personal: http://www.ioe.ac.uk/hgpersonal/
> Multilevel: http://www.ioe.ac.uk/multilevel/
> MLwiN: http://www.ioe.ac.uk/mlwin/
>
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