Benchmarking survival outcomes: A funnel plot for survival data

Statistical Methods in Medical Research, vol. 31, pp. 1171–1183

Abstract

Benchmarking is commonly used in many healthcare settings to monitor clinical performance, with the aim of increasing cost-effectiveness and safe care of patients. The funnel plot is a popular tool in visualizing the performance of a healthcare center in relation to other centers and to a target, taking into account statistical uncertainty. In this paper, we develop a methodology for constructing funnel plots for survival data. The method takes into account censoring and can deal with differences in censoring distributions across centers. Practical issues in implementing the methodology are discussed, particularly in the setting of benchmarking clinical outcomes for hematopoietic stem cell transplantation. A simulation study is performed to assess the performance of the funnel plots under several scenarios. Our methodology is illustrated using data from the European Society for Blood and Marrow Transplantation benchmarking project.

Authors 8

1. Hein Putter corresponding Aachen Department of Biomedical Data Sciences

   Leiden University Medical Center

   Affiliation as printed

   Department of Biomedical Data Sciences, Leiden University Medical Center, the Netherlands

2. Dirk‐Jan Eikema Aachen Department of Biomedical Data Sciences

   Leiden University Medical Center

   Affiliation as printed

   Department of Biomedical Data Sciences, Leiden University Medical Center, the Netherlands

3. Liesbeth C. de Wreede Aachen Department of Biomedical Data Sciences

   Leiden University Medical Center

   Affiliation as printed

   Department of Biomedical Data Sciences, Leiden University Medical Center, the Netherlands

4. Eoin McGrath
   Affiliation as printed

   EBMT, Barcelona, Spain

5. Isabel Sánchez‐Ortega

   Institut Català d'Oncologia

   Affiliation as printed

   Catalan Institute of Oncology, Barcelona, Spain

6. Riccardo Saccardi

   Azienda Ospedaliero-Universitaria Careggi

   Affiliation as printed

   Careggi University Hospital, Florence, Italy

7. John Andrew Snowden

   Sheffield Teaching Hospitals NHS Foundation Trust

   Affiliation as printed

   Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, UK

8. Erik W. van Zwet Aachen Department of Biomedical Data Sciences

   Leiden University Medical Center

   Affiliation as printed

   Department of Biomedical Data Sciences, Leiden University Medical Center, the Netherlands