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What Are the Characteristics That Explain Hospital Quality? A Longitudinal Pridit Approach


  • Robert D. Lieberthal,

  • Dominique M. Comer

  • The Society of Actuaries provided funding for this work through their Health Section. Part of Dr. Comer's time spent on this research was funded by a Postdoctoral Fellowship award on Health Outcomes from the PhRMA Foundation. We would like to thank the Society of Actuaries Project Oversight Group (POG), which provided advice and guidance during the course of the project. Katie O'Connell also provided valuable research assistance. A version of this work was originally published as a report by the Society of Actuaries under the title “Validating the PRIDIT Method for Determining Hospital Quality with Outcomes Data” and presented at the 2013 ARIA Annual Meeting. Muhammed Altuntas provided valuable comments and feedback.


Health outcomes vary substantially between high- and low-quality institutions, meaning the difference between life and death in some cases. The prior literature has identified a number of variables that can be used to determine hospital quality, but methodologies for combining variables into an overall measure of hospital quality are not well developed. This analysis builds on the prior investigation of hospital quality by evaluating a method originally developed for the detection of health-care fraud, Pridit, in the context of determining hospital quality. We developed a theoretical model to justify the application of Pridit to the hospital quality setting and then applied the Pridit method to a national, multiyear data set on U.S. hospital quality variables and outcomes. The results demonstrate how the Pridit method can be used predictively, in order to predict future health outcomes based on currently available quality measures. These results inform the use of Pridit, and other unsupervised learning methods, in fraud detection and other settings where valid and reliable outcomes variables are difficult to obtain. The empirical results obtained in this study may also be of use to health insurers and policymakers who aim to improve quality in the hospital setting.