Flexible random-effects models using Bayesian semi-parametric models: applications to institutional comparisons.

Random effects models are used in many applications in medical statistics, including meta-analysis, cluster randomized trials and comparisons of health care providers. This paper provides a tutorial on the practical implementation of a flexible random effects model based on methodology developed in Bayesian non-parametrics literature, and implemented in freely available software. The approach is applied to the problem of hospital comparisons using routine performance data, and among other benefits provides a diagnostic to detect clusters of providers with unusual results, thus avoiding problems caused by masking in traditional parametric approaches. By providing code for Winbugs we hope that the model can be used by applied statisticians working in a wide variety of applications.