Template Matching for Auditing Hospital Cost and Quality

Authors

  • Jeffrey H. Silber M.D., Ph.D.,

    Corresponding author
    1. The Department of Pediatrics, The University of Pennsylvania School of Medicine, Philadelphia, PA
    2. Department of Anesthesiology and Critical Care, The University of Pennsylvania School of Medicine, Philadelphia, PA
    3. Department of Health Care Management, The Wharton School, The University of Pennsylvania, Philadelphia, PA
    4. The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA
    • Address correspondence to Dr. Jeffrey H. Silber, Center for Outcomes Research, The Children's Hospital of Philadelphia, 3535 Market Street, Suite 1029, Philadelphia, PA 19104; e-mail: silberj@wharton.upenn.edu.

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  • Paul R. Rosenbaum Ph.D.,

    1. The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA
    2. Department of Statistics, The Wharton School, The University of Pennsylvania, Philadelphia, PA
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  • Richard N. Ross M.S.,

    1. Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, PA
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  • Justin M. Ludwig M.A.,

    1. Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, PA
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  • Wei Wang Ph.D.,

    1. Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, PA
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  • Bijan A. Niknam B.S.,

    1. Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, PA
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  • Nabanita Mukherjee Ph.D.,

    1. Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, PA
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  • Philip A. Saynisch A.B.,

    1. Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, PA
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  • Orit Even-Shoshan M.S.,

    1. The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA
    2. Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, PA
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  • Rachel R. Kelz M.D.,

    1. Department of Surgery, The University of Pennsylvania School of Medicine, Philadelphia, PA
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  • Lee A. Fleisher M.D.

    1. Department of Anesthesiology and Critical Care, The University of Pennsylvania School of Medicine, Philadelphia, PA
    2. The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA
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Abstract

Objective

Develop an improved method for auditing hospital cost and quality.

Data Sources/Setting

Medicare claims in general, gynecologic and urologic surgery, and orthopedics from Illinois, Texas, and New York between 2004 and 2006.

Study Design

A template of 300 representative patients was constructed and then used to match 300 patients at hospitals that had a minimum of 500 patients over a 3-year study period.

Data Collection/Extraction Methods

From each of 217 hospitals we chose 300 patients most resembling the template using multivariate matching.

Principal Findings

The matching algorithm found close matches on procedures and patient characteristics, far more balanced than measured covariates would be in a randomized clinical trial. These matched samples displayed little to no differences across hospitals in common patient characteristics yet found large and statistically significant hospital variation in mortality, complications, failure-to-rescue, readmissions, length of stay, ICU days, cost, and surgical procedure length. Similar patients at different hospitals had substantially different outcomes.

Conclusion

The template-matched sample can produce fair, directly standardized audits that evaluate hospitals on patients with similar characteristics, thereby making benchmarking more believable. Through examining matched samples of individual patients, administrators can better detect poor performance at their hospitals and better understand why these problems are occurring.

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