Table 1. Strengths and weaknesses of strategies for handling missing data

Methodological Considerations in Generating Provider Performance Scores

Reason data are missingData missing in a way that is not related to true performance (e.g., missing at random)Data missing in a way that is related to true performance (e.g., low performers not reporting data)
Option 1: ImputationStronger: may reduce the risk of misclassification due to chanceWeaker: may introduce systematic performance misclassification
Option 2: Report the average scoreStronger: will not result in systematic performance misclassificationWeaker: high likelihood of resulting in systematic performance misclassification; and creates incentive not to report low performance
Option 3: Report only the available dataStronger: will not result in systematic performance misclassificationWeaker: may create incentive not to report low performance
Option 4: Report only when providers are not missing any dataStronger: will not result in systematic performance misclassificationWeaker: may create incentive not to report low performance
Option 5: Report the lowest possible scoreWeaker: high likelihood of resulting in systematic performance misclassification*Stronger: potentially less likely to result in systematic performance misclassification; creates incentive to report all performance data
Option 6: Report the lowest observed scoreWeaker: high likelihood of resulting in systematic performance misclassification*Stronger: potentially less likely to result in systematic performance misclassification; creates incentive to report all performance data

* For example, if providers with fewer patients are more likely to have missing data (regardless of their performance), then these providers will be systematically misclassified as low performers.

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Current as of September 2011
Internet Citation: Table 1. Strengths and weaknesses of strategies for handling missing data: Methodological Considerations in Generating Provider Performance Scores. September 2011. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/value/perfscoresmethods/perfsctab1.html