Incorporating natural variation into IVF clinic league tables: The Expected Rank

<p<Abstract</p< <p<Background</p< <p<Rankings based on outcome are often used to present health care provider performance. These rankings do however not reflect that part of the variation in outcome between providers is caused by natural variation, and not by any differ...
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Autor*in:	Eijkemans Marinus JC [verfasserIn] Lingsma Hester F [verfasserIn] Steyerberg Ewout W [verfasserIn]

Format:	E-Artikel
Sprache:	Englisch

Erschienen:	2009

Übergeordnetes Werk:	In: BMC Medical Research Methodology - BMC, 2003, 9(2009), 1, p 53
Übergeordnetes Werk:	volume:9 ; year:2009 ; number:1, p 53

Links:	Link aufrufen Link aufrufen Link aufrufen Journal toc

DOI / URN:	10.1186/1471-2288-9-53

Katalog-ID:	DOAJ063274884

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520			\|a <p<Abstract</p< <p<Background</p< <p<Rankings based on outcome are often used to present health care provider performance. These rankings do however not reflect that part of the variation in outcome between providers is caused by natural variation, and not by any differences in quality of care. The aim of this study is to compare standard methods for ranking with a novel method that takes into account natural variation.</p< <p<Methods</p< <p<We used data on the number of treatment cycles and the number of pregnancies of 13 Dutch IVF clinics from 2004. We calculated the Expected Rank (ER), an estimate of the true rank of a provider, accounting for natural variation. We rescaled the ER to obtain the Percentile based on ER (PCER), that can be interpreted as the probability that a clinic is worse than a randomly selected other clinic. We also calculated a measure for rankability ρ, which is the part of variation between providers that is due to true differences (as opposed to natural variation).</p< <p<Results</p< <p<The expected ranks ranged from 1.4 to 11.9 instead of the original ranks 1–13. The ER showed that some clinics performed very similar, which would be disregarded when using standard ranks. The PCER ranged from 7% to 88%. Rankability was substantial (ρ = 0.9)</p< <p<Conclusion</p< <p<The Expected Rank provides a way to combine the attractiveness of a ranking, a single number and easy interpretation, with reliable analyses that does justice to the providers, and also allows individual comparisons.</p<
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allfields	10.1186/1471-2288-9-53 doi (DE-627)DOAJ063274884 (DE-599)DOAJf70a80360d684f1caeaa22d6eb8ba03e DE-627 ger DE-627 rakwb eng R5-920 Eijkemans Marinus JC verfasserin aut Incorporating natural variation into IVF clinic league tables: The Expected Rank 2009 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier <p<Abstract</p< <p<Background</p< <p<Rankings based on outcome are often used to present health care provider performance. These rankings do however not reflect that part of the variation in outcome between providers is caused by natural variation, and not by any differences in quality of care. The aim of this study is to compare standard methods for ranking with a novel method that takes into account natural variation.</p< <p<Methods</p< <p<We used data on the number of treatment cycles and the number of pregnancies of 13 Dutch IVF clinics from 2004. We calculated the Expected Rank (ER), an estimate of the true rank of a provider, accounting for natural variation. We rescaled the ER to obtain the Percentile based on ER (PCER), that can be interpreted as the probability that a clinic is worse than a randomly selected other clinic. We also calculated a measure for rankability ρ, which is the part of variation between providers that is due to true differences (as opposed to natural variation).</p< <p<Results</p< <p<The expected ranks ranged from 1.4 to 11.9 instead of the original ranks 1–13. The ER showed that some clinics performed very similar, which would be disregarded when using standard ranks. The PCER ranged from 7% to 88%. Rankability was substantial (ρ = 0.9)</p< <p<Conclusion</p< <p<The Expected Rank provides a way to combine the attractiveness of a ranking, a single number and easy interpretation, with reliable analyses that does justice to the providers, and also allows individual comparisons.</p< Medicine (General) Lingsma Hester F verfasserin aut Steyerberg Ewout W verfasserin aut In BMC Medical Research Methodology BMC, 2003 9(2009), 1, p 53 (DE-627)326643818 (DE-600)2041362-2 14712288 nnns volume:9 year:2009 number:1, p 53 https://doi.org/10.1186/1471-2288-9-53 kostenfrei https://doaj.org/article/f70a80360d684f1caeaa22d6eb8ba03e kostenfrei http://www.biomedcentral.com/1471-2288/9/53 kostenfrei https://doaj.org/toc/1471-2288 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_702 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2031 GBV_ILN_2038 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2056 GBV_ILN_2057 GBV_ILN_2061 GBV_ILN_2111 GBV_ILN_2113 GBV_ILN_2190 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 9 2009 1, p 53
spelling	10.1186/1471-2288-9-53 doi (DE-627)DOAJ063274884 (DE-599)DOAJf70a80360d684f1caeaa22d6eb8ba03e DE-627 ger DE-627 rakwb eng R5-920 Eijkemans Marinus JC verfasserin aut Incorporating natural variation into IVF clinic league tables: The Expected Rank 2009 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier <p<Abstract</p< <p<Background</p< <p<Rankings based on outcome are often used to present health care provider performance. These rankings do however not reflect that part of the variation in outcome between providers is caused by natural variation, and not by any differences in quality of care. The aim of this study is to compare standard methods for ranking with a novel method that takes into account natural variation.</p< <p<Methods</p< <p<We used data on the number of treatment cycles and the number of pregnancies of 13 Dutch IVF clinics from 2004. We calculated the Expected Rank (ER), an estimate of the true rank of a provider, accounting for natural variation. We rescaled the ER to obtain the Percentile based on ER (PCER), that can be interpreted as the probability that a clinic is worse than a randomly selected other clinic. We also calculated a measure for rankability ρ, which is the part of variation between providers that is due to true differences (as opposed to natural variation).</p< <p<Results</p< <p<The expected ranks ranged from 1.4 to 11.9 instead of the original ranks 1–13. The ER showed that some clinics performed very similar, which would be disregarded when using standard ranks. The PCER ranged from 7% to 88%. Rankability was substantial (ρ = 0.9)</p< <p<Conclusion</p< <p<The Expected Rank provides a way to combine the attractiveness of a ranking, a single number and easy interpretation, with reliable analyses that does justice to the providers, and also allows individual comparisons.</p< Medicine (General) Lingsma Hester F verfasserin aut Steyerberg Ewout W verfasserin aut In BMC Medical Research Methodology BMC, 2003 9(2009), 1, p 53 (DE-627)326643818 (DE-600)2041362-2 14712288 nnns volume:9 year:2009 number:1, p 53 https://doi.org/10.1186/1471-2288-9-53 kostenfrei https://doaj.org/article/f70a80360d684f1caeaa22d6eb8ba03e kostenfrei http://www.biomedcentral.com/1471-2288/9/53 kostenfrei https://doaj.org/toc/1471-2288 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_702 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2031 GBV_ILN_2038 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2056 GBV_ILN_2057 GBV_ILN_2061 GBV_ILN_2111 GBV_ILN_2113 GBV_ILN_2190 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 9 2009 1, p 53
allfields_unstemmed	10.1186/1471-2288-9-53 doi (DE-627)DOAJ063274884 (DE-599)DOAJf70a80360d684f1caeaa22d6eb8ba03e DE-627 ger DE-627 rakwb eng R5-920 Eijkemans Marinus JC verfasserin aut Incorporating natural variation into IVF clinic league tables: The Expected Rank 2009 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier <p<Abstract</p< <p<Background</p< <p<Rankings based on outcome are often used to present health care provider performance. These rankings do however not reflect that part of the variation in outcome between providers is caused by natural variation, and not by any differences in quality of care. The aim of this study is to compare standard methods for ranking with a novel method that takes into account natural variation.</p< <p<Methods</p< <p<We used data on the number of treatment cycles and the number of pregnancies of 13 Dutch IVF clinics from 2004. We calculated the Expected Rank (ER), an estimate of the true rank of a provider, accounting for natural variation. We rescaled the ER to obtain the Percentile based on ER (PCER), that can be interpreted as the probability that a clinic is worse than a randomly selected other clinic. We also calculated a measure for rankability ρ, which is the part of variation between providers that is due to true differences (as opposed to natural variation).</p< <p<Results</p< <p<The expected ranks ranged from 1.4 to 11.9 instead of the original ranks 1–13. The ER showed that some clinics performed very similar, which would be disregarded when using standard ranks. The PCER ranged from 7% to 88%. Rankability was substantial (ρ = 0.9)</p< <p<Conclusion</p< <p<The Expected Rank provides a way to combine the attractiveness of a ranking, a single number and easy interpretation, with reliable analyses that does justice to the providers, and also allows individual comparisons.</p< Medicine (General) Lingsma Hester F verfasserin aut Steyerberg Ewout W verfasserin aut In BMC Medical Research Methodology BMC, 2003 9(2009), 1, p 53 (DE-627)326643818 (DE-600)2041362-2 14712288 nnns volume:9 year:2009 number:1, p 53 https://doi.org/10.1186/1471-2288-9-53 kostenfrei https://doaj.org/article/f70a80360d684f1caeaa22d6eb8ba03e kostenfrei http://www.biomedcentral.com/1471-2288/9/53 kostenfrei https://doaj.org/toc/1471-2288 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_702 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2031 GBV_ILN_2038 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2056 GBV_ILN_2057 GBV_ILN_2061 GBV_ILN_2111 GBV_ILN_2113 GBV_ILN_2190 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 9 2009 1, p 53
allfieldsGer	10.1186/1471-2288-9-53 doi (DE-627)DOAJ063274884 (DE-599)DOAJf70a80360d684f1caeaa22d6eb8ba03e DE-627 ger DE-627 rakwb eng R5-920 Eijkemans Marinus JC verfasserin aut Incorporating natural variation into IVF clinic league tables: The Expected Rank 2009 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier <p<Abstract</p< <p<Background</p< <p<Rankings based on outcome are often used to present health care provider performance. These rankings do however not reflect that part of the variation in outcome between providers is caused by natural variation, and not by any differences in quality of care. The aim of this study is to compare standard methods for ranking with a novel method that takes into account natural variation.</p< <p<Methods</p< <p<We used data on the number of treatment cycles and the number of pregnancies of 13 Dutch IVF clinics from 2004. We calculated the Expected Rank (ER), an estimate of the true rank of a provider, accounting for natural variation. We rescaled the ER to obtain the Percentile based on ER (PCER), that can be interpreted as the probability that a clinic is worse than a randomly selected other clinic. We also calculated a measure for rankability ρ, which is the part of variation between providers that is due to true differences (as opposed to natural variation).</p< <p<Results</p< <p<The expected ranks ranged from 1.4 to 11.9 instead of the original ranks 1–13. The ER showed that some clinics performed very similar, which would be disregarded when using standard ranks. The PCER ranged from 7% to 88%. Rankability was substantial (ρ = 0.9)</p< <p<Conclusion</p< <p<The Expected Rank provides a way to combine the attractiveness of a ranking, a single number and easy interpretation, with reliable analyses that does justice to the providers, and also allows individual comparisons.</p< Medicine (General) Lingsma Hester F verfasserin aut Steyerberg Ewout W verfasserin aut In BMC Medical Research Methodology BMC, 2003 9(2009), 1, p 53 (DE-627)326643818 (DE-600)2041362-2 14712288 nnns volume:9 year:2009 number:1, p 53 https://doi.org/10.1186/1471-2288-9-53 kostenfrei https://doaj.org/article/f70a80360d684f1caeaa22d6eb8ba03e kostenfrei http://www.biomedcentral.com/1471-2288/9/53 kostenfrei https://doaj.org/toc/1471-2288 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_702 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2031 GBV_ILN_2038 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2056 GBV_ILN_2057 GBV_ILN_2061 GBV_ILN_2111 GBV_ILN_2113 GBV_ILN_2190 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 9 2009 1, p 53
allfieldsSound	10.1186/1471-2288-9-53 doi (DE-627)DOAJ063274884 (DE-599)DOAJf70a80360d684f1caeaa22d6eb8ba03e DE-627 ger DE-627 rakwb eng R5-920 Eijkemans Marinus JC verfasserin aut Incorporating natural variation into IVF clinic league tables: The Expected Rank 2009 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier <p<Abstract</p< <p<Background</p< <p<Rankings based on outcome are often used to present health care provider performance. These rankings do however not reflect that part of the variation in outcome between providers is caused by natural variation, and not by any differences in quality of care. The aim of this study is to compare standard methods for ranking with a novel method that takes into account natural variation.</p< <p<Methods</p< <p<We used data on the number of treatment cycles and the number of pregnancies of 13 Dutch IVF clinics from 2004. We calculated the Expected Rank (ER), an estimate of the true rank of a provider, accounting for natural variation. We rescaled the ER to obtain the Percentile based on ER (PCER), that can be interpreted as the probability that a clinic is worse than a randomly selected other clinic. We also calculated a measure for rankability ρ, which is the part of variation between providers that is due to true differences (as opposed to natural variation).</p< <p<Results</p< <p<The expected ranks ranged from 1.4 to 11.9 instead of the original ranks 1–13. The ER showed that some clinics performed very similar, which would be disregarded when using standard ranks. The PCER ranged from 7% to 88%. Rankability was substantial (ρ = 0.9)</p< <p<Conclusion</p< <p<The Expected Rank provides a way to combine the attractiveness of a ranking, a single number and easy interpretation, with reliable analyses that does justice to the providers, and also allows individual comparisons.</p< Medicine (General) Lingsma Hester F verfasserin aut Steyerberg Ewout W verfasserin aut In BMC Medical Research Methodology BMC, 2003 9(2009), 1, p 53 (DE-627)326643818 (DE-600)2041362-2 14712288 nnns volume:9 year:2009 number:1, p 53 https://doi.org/10.1186/1471-2288-9-53 kostenfrei https://doaj.org/article/f70a80360d684f1caeaa22d6eb8ba03e kostenfrei http://www.biomedcentral.com/1471-2288/9/53 kostenfrei https://doaj.org/toc/1471-2288 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_702 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2031 GBV_ILN_2038 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2056 GBV_ILN_2057 GBV_ILN_2061 GBV_ILN_2111 GBV_ILN_2113 GBV_ILN_2190 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 9 2009 1, p 53
language	English
source	In BMC Medical Research Methodology 9(2009), 1, p 53 volume:9 year:2009 number:1, p 53
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authorswithroles_txt_mv	Eijkemans Marinus JC @@aut@@ Lingsma Hester F @@aut@@ Steyerberg Ewout W @@aut@@
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callnumber-first	R - Medicine
author	Eijkemans Marinus JC
spellingShingle	Eijkemans Marinus JC misc R5-920 misc Medicine (General) Incorporating natural variation into IVF clinic league tables: The Expected Rank
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topic_title	R5-920 Incorporating natural variation into IVF clinic league tables: The Expected Rank
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title	Incorporating natural variation into IVF clinic league tables: The Expected Rank
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title_full	Incorporating natural variation into IVF clinic league tables: The Expected Rank
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author_browse	Eijkemans Marinus JC Lingsma Hester F Steyerberg Ewout W
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title_sort	incorporating natural variation into ivf clinic league tables: the expected rank
callnumber	R5-920
title_auth	Incorporating natural variation into IVF clinic league tables: The Expected Rank
abstract	<p<Abstract</p< <p<Background</p< <p<Rankings based on outcome are often used to present health care provider performance. These rankings do however not reflect that part of the variation in outcome between providers is caused by natural variation, and not by any differences in quality of care. The aim of this study is to compare standard methods for ranking with a novel method that takes into account natural variation.</p< <p<Methods</p< <p<We used data on the number of treatment cycles and the number of pregnancies of 13 Dutch IVF clinics from 2004. We calculated the Expected Rank (ER), an estimate of the true rank of a provider, accounting for natural variation. We rescaled the ER to obtain the Percentile based on ER (PCER), that can be interpreted as the probability that a clinic is worse than a randomly selected other clinic. We also calculated a measure for rankability ρ, which is the part of variation between providers that is due to true differences (as opposed to natural variation).</p< <p<Results</p< <p<The expected ranks ranged from 1.4 to 11.9 instead of the original ranks 1–13. The ER showed that some clinics performed very similar, which would be disregarded when using standard ranks. The PCER ranged from 7% to 88%. Rankability was substantial (ρ = 0.9)</p< <p<Conclusion</p< <p<The Expected Rank provides a way to combine the attractiveness of a ranking, a single number and easy interpretation, with reliable analyses that does justice to the providers, and also allows individual comparisons.</p<
abstractGer	<p<Abstract</p< <p<Background</p< <p<Rankings based on outcome are often used to present health care provider performance. These rankings do however not reflect that part of the variation in outcome between providers is caused by natural variation, and not by any differences in quality of care. The aim of this study is to compare standard methods for ranking with a novel method that takes into account natural variation.</p< <p<Methods</p< <p<We used data on the number of treatment cycles and the number of pregnancies of 13 Dutch IVF clinics from 2004. We calculated the Expected Rank (ER), an estimate of the true rank of a provider, accounting for natural variation. We rescaled the ER to obtain the Percentile based on ER (PCER), that can be interpreted as the probability that a clinic is worse than a randomly selected other clinic. We also calculated a measure for rankability ρ, which is the part of variation between providers that is due to true differences (as opposed to natural variation).</p< <p<Results</p< <p<The expected ranks ranged from 1.4 to 11.9 instead of the original ranks 1–13. The ER showed that some clinics performed very similar, which would be disregarded when using standard ranks. The PCER ranged from 7% to 88%. Rankability was substantial (ρ = 0.9)</p< <p<Conclusion</p< <p<The Expected Rank provides a way to combine the attractiveness of a ranking, a single number and easy interpretation, with reliable analyses that does justice to the providers, and also allows individual comparisons.</p<
abstract_unstemmed	<p<Abstract</p< <p<Background</p< <p<Rankings based on outcome are often used to present health care provider performance. These rankings do however not reflect that part of the variation in outcome between providers is caused by natural variation, and not by any differences in quality of care. The aim of this study is to compare standard methods for ranking with a novel method that takes into account natural variation.</p< <p<Methods</p< <p<We used data on the number of treatment cycles and the number of pregnancies of 13 Dutch IVF clinics from 2004. We calculated the Expected Rank (ER), an estimate of the true rank of a provider, accounting for natural variation. We rescaled the ER to obtain the Percentile based on ER (PCER), that can be interpreted as the probability that a clinic is worse than a randomly selected other clinic. We also calculated a measure for rankability ρ, which is the part of variation between providers that is due to true differences (as opposed to natural variation).</p< <p<Results</p< <p<The expected ranks ranged from 1.4 to 11.9 instead of the original ranks 1–13. The ER showed that some clinics performed very similar, which would be disregarded when using standard ranks. The PCER ranged from 7% to 88%. Rankability was substantial (ρ = 0.9)</p< <p<Conclusion</p< <p<The Expected Rank provides a way to combine the attractiveness of a ranking, a single number and easy interpretation, with reliable analyses that does justice to the providers, and also allows individual comparisons.</p<
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title_short	Incorporating natural variation into IVF clinic league tables: The Expected Rank
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