Assessing healthcare providers' performance with and without risk adjustment
- Authors: Morales-Silva, Daniel
- Date: 2018
- Type: Text , Thesis , PhD
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- Description: This study focuses on how healthcare data can be used to draw comparisons between healthcare providers (surgeons or hospitals). Depending on the type of access to datasets, these comparisons can be done with or without risk adjustment. For us, risk adjustment refers to the use of patient-level information to explain variation in healthcare spending, resource utilisation and health outcomes. For unadjusted comparisons, we highlight the diagnostic potential that radar plots offer for reporting on outcome indicators. These outcome indicators were obtained from hospital admissions of patients undergoing certain surgical procedures. We address two drawbacks of radar plots: presence of missing information and order of indicators. By introducing a consolidated view at provider level, we define an uncomplicated ranking of providers which can be used to identify potential low and high performers. For risk adjusted comparisons, we introduce a novel and robust methodology that enables comparisons of healthcare providers across multiple hierarchies, namely, surgeons, teams, departments and hospitals, using a consistent approach. Our methodology puts the patient at the centre of the analysis, and thus, can be used for personalised predictions (e.g. expected length of stay, costs and probability of being transferred to intensive care unit). Our findings suggest that the observed variation in selected outcome indicators, such as length of stay and charges of healthcare providers, cannot be explained by patient characteristics alone. Importantly, we have also observed that the perceived performance, on selected outcome indicators, of providers can change substantially following risk adjustment. Healthcare is unique in that clinical expertise is essential in guiding decision making and in informing all statistical models that seek to describe patient outcomes. For future iterations of our models, we will seek greater clinical input.
- Description: Doctor of Philosophy
Assessing healthcare providers' performance with and without risk adjustment
- Authors: Morales-Silva, Daniel
- Date: 2020
- Type: Text , Journal article
- Relation: Bulletin of the Australian Mathematical Society Vol. 102, no. 1 (AUG 2020), p. 172-173
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Canonical duality theory and triality for solving general global optimization problems in complex systems
- Authors: Morales-Silva, Daniel , Gao, David
- Date: 2015
- Type: Text , Journal article
- Relation: Mathematics and Mechanics of Complex Systems Vol. 3, no. 2 (2015), p. 139-161
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- Description: General nonconvex optimization problems are studied by using the canonical duality-triality theory. The triality theory is proved for sums of exponentials and quartic polynomials, which solved an open problem left in 2003. This theory can be used to find the global minimum and local extrema, which bridges a gap between global optimization and nonconvex mechanics. Detailed applications are illustrated by several examples. © 2015 Mathematical Sciences Publishers.
Complete solutions and triality theory to a nonconvex optimization problem with double-well potential in Rn
- Authors: Morales-Silva, Daniel , Gao, David
- Date: 2013
- Type: Text , Journal article
- Relation: Numerical Algebra, Control and Optimization Vol. 3, no. 2 (2013), p. 271-282
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- Description: The main purpose of this research note is to show that the triality theory can always be used to identify both global minimizer and the biggest local maximizer in global optimization. An open problem left on the double- min duality is solved for a nonconvex optimization problem with double-well potential in ℝn, which leads to a complete set of analytical solutions. Also a convergency theorem is proved for linear perturbation canonical dual method, which can be used for solving global optimization problems with multiple so- lutions. The methods and results presented in this note pave the way towards the proof of the triality theory in general cases.
G-coupling functions
- Authors: Morales-Silva, Daniel , Rubinov, Alex , Sosa, Wilfredo
- Date: 2009
- Type: Text , Journal article
- Relation: Optimization Vol. 58, no. 2 (2009), p. 193-211
- Full Text: false
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- Description: GAP functions are useful for solving optimization problems, but the literature contains a variety of different concepts of GAP functions. It is interesting to point out that these concepts have many similarities. Here we introduce G-coupling functions, thus presenting a way to take advantage of these common properties.
G-coupling functions and properties of strongly star-shaped cones
- Authors: Morales-Silva, Daniel
- Date: 2009
- Type: Text , Thesis , PhD
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- Description: The main part of this thesis presents a new approach to the topic of conjugation, with applications to various optimization problems. It does so by introducing (what we call) G-coupling functions.
- Description: Doctor of Philosophy
Properties of strongly star shaped cones
- Authors: Morales-Silva, Daniel
- Date: 2007
- Type: Text , Journal article
- Relation: Pacific Journal of Optimization Vol. 3, no. 2 (2007), p. 379-386
- Full Text: false
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- Description: In problems of vector optimization, with preferences that are not necessarily a pre-order relation, the strongly star shaped cones are very important in order to get a scalarization of these problems. In this work we present some properties of these cones and also a characterization for a special type.
- Description: C1
- Description: 2003004940
Using radar plots for performance benchmarking at patient and hospital levels using an Australian orthopaedics dataset
- Authors: Morales-Silva, Daniel , McPherson, Cameron , Pineda-Villavicencio, Guillermo , Atchison, Rory
- Date: 2020
- Type: Text , Journal article
- Relation: Health Informatics Journal Vol. 26, no. 3 (2020), p. 2119-2137
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- Description: This study will highlight the diagnostic potential that radar plots display for reporting on performance benchmarking from patient admissions to hospital for surgical procedures. Two drawbacks of radar plots – the presence of missing information and ordering of indicators – are addressed. Ten different orthopaedic surgery procedures were considered in this study. Moreover, twelve outcome indicators were provided for each of the 10 surgeries of interest. These indicators were displayed using a radar plot, which we call a scorecard. At the hospital level, we propose a facile process by which to consolidate our 10 scorecards into one. We addressed the ordering of indicators in our scorecards by considering the national median of the indicators as a benchmark. Furthermore, our the consolidated scorecard facilitates concise visualisation and dissemination of complex data. It also enables the classification of providers into potential low and high performers that warrant further investigation. In conclusion, radar plots provide a clear and effective comparative tool for discerning multiple outcome indicators against the benchmarks of patient admission. A case study between two top and bottom performers on a consolidated scorecard (at hospital level) showed that medical provider charges varied more than other outcome indicators. © The Author(s) 2020.