Cai T, Zaslavsky AM. Bayesian hierarchical modeling of substate area estimates from the Medicare CAHPS survey.
Stat Med 2019;
38:1662-1677. [PMID:
30648283 DOI:
10.1002/sim.8068]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 10/12/2018] [Accepted: 11/27/2018] [Indexed: 11/12/2022]
Abstract
Each year, surveys are conducted to assess the quality of care for Medicare beneficiaries, using instruments from the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) program. Currently, survey measures presented for Fee-for-Service beneficiaries are either pooled at the state level or unpooled for smaller substate areas nested within the state; the choice in each state is based on statistical tests of measure heterogeneity across areas within state. We fit spatial-temporal Bayesian random-effects models using a flexible parameterization to estimate mean scores for each of the domains formed by 94 areas in 32 states measured over 5 years. A Bayesian hat matrix provides a heuristic interpretation of the way the model combines information for estimates in these domains. The model can be used to choose between reporting of state- or substate-level direct estimates in each state, or as a source of alternative small-area estimates superior to either direct estimate. We compare several candidate models using log pseudomarginal likelihood and posterior predictive checks. Results from the best-performing model for 8 measures surveyed from 2012 to 2016 show substantial reductions in mean squared error (MSE) over direct estimates.
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