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Hypothesis Testing Fundamentals
1.
HealthCare Quality Improvement
Solutions © 2012 by HealthCare Quality Improvement Solutions, LLC
2.
• What is
hypothesis testing? A quantitative method for answering questions and determining whether potential factors significantly effect process performance 2 © 2012 by HealthCare Quality Improvement Solutions, LLC
3.
• Primary purpose
from a quality improvement perspective: Determine whether the outcome of interest is produced by a similar or dissimilar process 3 © 2012 by HealthCare Quality Improvement Solutions, LLC
4.
Hospital
Hospital Potential Performance Performance Factors Discharge Discharge Rx ACEI 75% Rx ACEI 75% Physician Similar Processes Dissimilar Processes 72% 95% 75% 71% 77% 60% P-Value 0.567 P-Value 0.001 4 © 2012 by HealthCare Quality Improvement Solutions, LLC
5.
Similar Processes
Dissimilar Processes • Critical few factors will • Critical few factors will not be identified be identified • Redesign the process • Focus quality improvement on the critical few factors 5 © 2012 by HealthCare Quality Improvement Solutions, LLC
6.
• Question to
be answered: Is the defendant innocent or guilty? • The defendant is presumed innocent until proven guilty In hypothesis testing this is known as the null hypothesis and is denoted H0 H0: Defendant is innocent • The plaintiff asserts that the defendant is guilty In hypothesis testing this is known as the alternate hypothesis and is denoted HA HA: Defendant is guilty 6 © 2012 by HealthCare Quality Improvement Solutions, LLC
7.
• Potential factor:
Arrival day of week • Question: Is there a significant difference in Pneumonia Antibiotic Timing (Median) between patients that arrive on a Weekday vs. Weekend? • Hypotheses: H0: Weekday Median = Weekend Median The antibiotic administration process is similar for weekdays and weekend – Arrival day of week does not significantly effect Pneumonia Antibiotic Timing HA: Weekday Median Weekend Median The antibiotic administration process is dissimilar for weekdays and weekend – Arrival day of week does significantly effect Pneumonia Antibiotic Timing and is among the Critical Few Factors 7 © 2012 by HealthCare Quality Improvement Solutions, LLC
8.
• The null
hypothesis H0: Asserts there is no difference among factors • The alternate hypothesis HA: Asserts that there is a difference among factors 8 © 2012 by HealthCare Quality Improvement Solutions, LLC
9.
Legal Process •
The legal process is not perfect Truth Innocent Guilty Innocent defendants can be found guilty by the jury Jury Innocent Correct Incorrect In hypothesis testing this is Decision Guilty Incorrect Correct known as a Type I Error – Rejecting the null Data Analysis hypothesis when it is true Guilty defendants can be Actual State found innocent by the jury H0 True H0 False In hypothesis testing this is Accept H0 Correct Type II known as a Type II Error Error - Decision – Accepting the null Reject H0 Type I Correct hypothesis when it is false Error - © 2012 by HealthCare Quality Improvement Solutions, LLC 9
10.
• The P-Value
is the chance of making a Type I Error if H0 is rejected • Decision Criteria: If the P-Value is less than or equal to - reject H0 If the P-Value is greater than - accept H0 10 © 2012 by HealthCare Quality Improvement Solutions, LLC
11.
• Let’s return
to the Pneumonia Antibiotic Timing question: Is there a significant difference in Pneumonia Antibiotic Timing (Median) between patients that arrive on a Weekday vs. Weekend? • Hypotheses: H0: Weekday Median = Weekend Median HA: Weekday Median Weekend Median • Level of Significance ( ) – also referred to as alpha 0.05 11 © 2012 by HealthCare Quality Improvement Solutions, LLC
12.
• Let’s return
to the Pneumonia Antibiotic Timing question: Is there a significant difference in Pneumonia Antibiotic Timing (Median) between patients that arrive on a Weekday vs. Weekend? Yes • Hypotheses: H0: Weekday Median = Weekend Median HA: Weekday Median Weekend Median • Level of Significance 0.05 P-Value 12 © 2012 by HealthCare Quality Improvement Solutions, LLC
13.
P-Value
• Investigate why it takes longer on the weekend to deliver the initial antibiotic. 13 © 2012 by HealthCare Quality Improvement Solutions, LLC
14.
• When H0
is rejected, the hypothesis test is considered statistically significant at the selected level • It indicates that the sample measurement is unlikely if the null hypothesis is true • QI Perspective: The sample measurements are likely being generated by dissimilar processes The factor is a critical factor effecting performance 14 © 2012 by HealthCare Quality Improvement Solutions, LLC
15.
Hospital
Hospital Potential Performance Performance Factors Discharge Discharge Rx ACEI 75% Rx ACEI 75% Physician Similar Processes Dissimilar Processes 72% 95% 75% 71% 77% 60% P-Value 0.567 P-Value 0.001 15 © 2012 by HealthCare Quality Improvement Solutions, LLC
16.
HealthCare Quality Improvement
Solutions Robert Sutter Contact Information Website: https://sites.google.com/site/robertsutterrnmbamha/ © 2012 by HealthCare Quality Improvement Solutions, LLC
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