ArticleStatistical methods in medical research2018
Guidelines on constructing funnel plots for quality indicators: A case study on mortality in intensive care unit patients.
Article in Statistical methods in medical research, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 3 of them syntheses that pooled it.
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Who cites it
23 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Breast Cancer Risk in over 1.3 Million Women on Antipsychotic Therapy: Life-Saving Drugs or Hidden Trigger for Breast Cancer?Medical sciences (Basel, Switzerland) · 2026Pooled it
- Evaluations of statistical methods for outlier detection when benchmarking in clinical registries: a systematic review.BMJ open · 2023Pooled it
- Meta-Analysis of Dyslipidemia Management for the Prevention of Ischemic Stroke Recurrence in China.Frontiers in neurology · 2020Pooled it
- Choosing an Appropriate Outlier-Detection Method When Comparing Institutional Performances in Clinical Audits.Biometrical journal. Biometrische Zeitschrift · 2026Article
- Measuring performance trajectories in lung cancer surgery: a longitudinal study using the French national hospital database from 2020 to 2024.BMJ health & care informatics · 2026Article
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- Ninety-Day Cost, Mortality and Hospital Disparities in Ischemic Stroke: Real-World Evidence from a Czech Administrative Database.Healthcare (Basel, Switzerland) · 2026Article
- Advancing Methods to Study Clinical Variation in Healthcare.Journal of evaluation in clinical practice · 2026Review
- Benchmarking and efficiency assessment in intensive care units: a systematic review protocol.Critical care science · 2026Article
- A method to identify prescription drug targets for health technology reassessment.International journal of technology assessment in health care · 2025Article
- Adult ependymoma: results from the Dutch Brain Tumour Registry on primary treatment and survival.Journal of neuro-oncology · 2025Article
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- Initial management of newly diagnosed WHO grade 2-3 adult meningioma following surgery: results from the Dutch Brain Tumour Registry (2016-2021).Journal of neuro-oncology · 2024Article
- Optimizing Hospital Performance Evaluation in Total Weight Loss Outcomes After Bariatric Surgery: A Retrospective Analysis to Guide Further Improvement in Dutch Hospitals.Obesity surgery · 2024Article
- Test-specific funnel plots for healthcare provider profiling leveraging individual- and summary-level information.Health services & outcomes research methodology · 2023Article
- Benchmarking survival outcomes: A funnel plot for survival data.Statistical methods in medical research · 2022Article
- Healthcare provider profiling: fixing observation period or fixing sample size?BMJ open quality · 2022Article
- Article
- Using data linkage for national surveillance of clinical quality indicators for dementia care among Australian aged care users.Scientific reports · 2021Article
Corrections and comments
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Funnel plots are graphical tools to assess and compare clinical performance of a group of care professionals or care institutions on a quality indicator against a benchmark. Incorrect construction of funnel plots may lead to erroneous assessment and incorrect decisions potentially with severe consequences. We provide workflow-based guidance for data analysts on constructing funnel plots for the evaluation of binary quality indicators, expressed as proportions, risk-adjusted rates or standardised rates. Our guidelines assume the following steps: (1) defining policy level input; (2) checking the quality of models used for case-mix correction; (3) examining whether the number of observations per hospital is sufficient; (4) testing for overdispersion of the values of the quality indicator; (5) testing whether the values of quality indicators are associated with institutional characteristics; and (6) specifying how the funnel plot should be constructed. We illustrate our guidelines using data from the Dutch National Intensive Care Evaluation registry. We expect that our guidelines will be useful to data analysts preparing funnel plots and to registries, or other organisations publishing quality indicators. This is particularly true if these people and organisations wish to use standard operating procedures when constructing funnel plots, perhaps to comply with the demands of certification.
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