Search citation statements
Paper Sections
Citation Types
Year Published
Publication Types
Relationship
Authors
Journals
Length of stay (LOS) is an important performance indicator for costing and hospital management and a key measure of efficiency of NHS. However, LOS is difficult to analyse because its statistical distribution is non-normal and LOS data habitually have many outliers. Furthermore, the usefulness of LOS for improving NHS performance is undermined because no adjustments are made for some key factors. This paper addresses both these problems. Health episodes statistics data from the UK NHS for 1997/98, and 1998/99 are analysed to investigate the effects of five key variables: admission method, discharge destination, provider (hospital) type, speciality and NHS region. All are found to influence LOS. The effects of some factors are substantial, and were not previously known, and so are not included in planned future NHS performance measures, e.g. LOS is at least 25% longer for patients transferred from other hospitals rather than admitted as an emergency; and LOS for patients discharged to private institutions is more than twice that for patients discharged to NHS institutions or their own home. The problem of finding the most appropriate statistical analysis for data of the LOS type is addressed by comparing standard general linear model methods with an advanced robust method called truncated maximum likelihood (TML). The TML methods are shown to have several advantages over standard methods, in terms of model fit and accuracy of parameter estimation. Implications of these findings for future use of LOS are considered.
Length of stay (LOS) is an important performance indicator for costing and hospital management and a key measure of efficiency of NHS. However, LOS is difficult to analyse because its statistical distribution is non-normal and LOS data habitually have many outliers. Furthermore, the usefulness of LOS for improving NHS performance is undermined because no adjustments are made for some key factors. This paper addresses both these problems. Health episodes statistics data from the UK NHS for 1997/98, and 1998/99 are analysed to investigate the effects of five key variables: admission method, discharge destination, provider (hospital) type, speciality and NHS region. All are found to influence LOS. The effects of some factors are substantial, and were not previously known, and so are not included in planned future NHS performance measures, e.g. LOS is at least 25% longer for patients transferred from other hospitals rather than admitted as an emergency; and LOS for patients discharged to private institutions is more than twice that for patients discharged to NHS institutions or their own home. The problem of finding the most appropriate statistical analysis for data of the LOS type is addressed by comparing standard general linear model methods with an advanced robust method called truncated maximum likelihood (TML). The TML methods are shown to have several advantages over standard methods, in terms of model fit and accuracy of parameter estimation. Implications of these findings for future use of LOS are considered.
This research dealt with making comparison of the independent group tests with the use of parametric technique. This test used mean as its central tendency measure. It was a better alternative to the ANOVA, the Welch test and the James test, because it gave a good control of Type I error rates and high power with ease in its calculation, for variance heterogeneity under a normal data. But the test was found not to be robust to non-normal data. Trimmed mean was used on the test as its central tendency measure under non-normality for two group condition, but as the number of groups increased above two, the test failed to give a good control of Type I error rates. As a result of this, the MOM estimator was applied on the test as its central tendency measure and is not influenced by the number of groups. However, under extreme condition of skewness and kurtosis, the MOM estimator could no longer control the Type I error rates. In this study, the Winsorized MOM estimator was used in the AG test, as a measure of its central tendency under non-normality. 5,000 data sets were simulated and analysed for each of the test in the research design with the use of Statistical Analysis Software (SAS) package. The results of the analysis shows that the Winsorized modified one step M-estimator in the Alexander-Govern (AGWMOM) test, gave the best control of Type I error rates under non-normality compared to the AG test, the AGMOM test, and the ANOVA, with the highest number of conditions for both lenient and stringent criteria of robustness.
This research examined the usage of the parametric method in comparing two or more means as independent group test, for instance, the Alexander-Govern (AG) test. The utilization of mean as the determinant for the center of distribution of variance diversity takes place in testing, and the test provides excellence in maintaining the amount of Type I error and giving immense sensitivity for a regular data. Unfortunately, it isineffective on irregular data, leading to the application of trimmed mean upon testing as the determinant for the center of distribution under irregular data for two group condition. However, as the group quantity is more than two, the estimator unsuccessfully provides excellence in maintaining the amount of Type I error. Therefore, an estimator high in effectiveness called the MOM estimator was introduced for the testing as the determinant for the center of distribution. Group quantity in a test does not affect the estimator, but it unsuccessfully providesexcellence in maintaining the amount of Type I error under intense asymmetry and unevenness. The application of Winsorized modified one-step M-estimator (WMOM) upon the Alexander-Govern testing takes place so that it can prevail against its drawbacks under irregular data in the presence of variance diversity, can eliminate the presence of the outside observation and can provide effectiveness for the testing on irregular data. Statistical Analysis Software (SAS) was used for the analysis of the tests. The results show that the AGWMOM test gave the most intense sensitivity under g = 0,5 and h = 0,5, for four group case and g = 0 and h = 0, under six group case, differing from three remaining tests and the sensitivity of the AG testing is said suffices and intense enough.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
customersupport@researchsolutions.com
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.