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The current study revealed that the Dutch PI hospital data infrastructure is heterogeneous, and the reported performance data under investigation can be regarded as largely implausible, particularly those of the Hip and Knee replacement indicators.
Likewise, the physicians were able to increase the frequency of remote interrogations to monitor elective replacement indicators or if the patient or device were otherwise considered as requiring more intensive follow-up.
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Likewise, we did not take into account the possible increase in device longevity resulting from delaying box change in patients on HM (in whom automatic alerts are available to warn of low battery charge), as well as an increase in FU frequency in patients with CFU in whom the battery is reaching the elective replacement indicator.
Results are presented separately for the Hip replacements indicator set and the Breast Cancer indicator set.
The standard deviation of the annual change in the benefit replacement rate indicator is calculated over all available observations.
The use of alternative thresholds beyond which the change in a benefit replacement rate indicator is identified as a reform shock.
The introduction of "reverse" reforms, measured as large changes in the benefit replacement rate indicator in the opposite direction, as additional control variables7.
In order to assess the sensitivity of the baseline results, we perform the three following robustness checks: The use of alternative thresholds beyond which the change in a benefit replacement rate indicator is identified as a reform shock.
In the baseline approach, a reform shock is identified when the benefit replacement rate indicator varies by more than two standard deviations of the annual variation calculated over all available observations.
There has been little work at an international level on this issue and we have developed and described a set of underpinning principles for indicator replacement and key issues that need to be considered by any organization or country planning to remove indicators from a clinical performance framework [ 15, 16].
Thus, the adaptation of dynamic norms may include the development of method for calculating the proposed indicators or replacement by indicators which are similar in meaning.
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com