What implications does the fact that low-frequency events in a small sample size will produce unreliable estimates of provider performance have for measuring PCI outcomes?
This fact has substantial implications for measuring PCI outcomes, as it means that certain measures are appropriately applied only to larger aggregated provider groupings where sample sizes are larger. Moreover, even the best risk-adjustment model cannot correct for potentially unmeasured confounders, and most risk-adjustment models perform less well at the extremes of risk. This requires a careful design of outcome measures to avoid the unintended consequence of either penalizing facilities or clinicians who take on more difficult cases or rewarding those who avoid certain high-risk patients requiring treatment.