The Department of Pediatrics, The University of Pennsylvania School of Medicine, Philadelphia, PA; Department of Anesthesiology and Critical Care, The University of Pennsylvania School of Medicine, Philadelphia, PA; Department of Health Care Management, The Wharton School, The University of Pennsylvania, Philadelphia, PA; The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA.
Health Serv Res. 2014 Oct;49(5):1475-97. doi: 10.1111/1475-6773.12226. Epub 2014 Sep 8.
Develop an improved method for auditing hospital cost and quality tailored to a specific hospital's patient population.
DATA SOURCES/SETTING: Medicare claims in general, gynecologic and urologic surgery, and orthopedics from Illinois, New York, and Texas between 2004 and 2006.
A template of 300 representative patients from a single index hospital was constructed and used to match 300 patients at 43 hospitals that had a minimum of 500 patients over a 3-year study period.
DATA COLLECTION/EXTRACTION METHODS: From each of 43 hospitals we chose 300 patients most resembling the template using multivariate matching.
We found close matches on procedures and patient characteristics, far more balanced than would be expected in a randomized trial. There were little to no differences between the index hospital's template and the 43 hospitals on most patient characteristics yet large and significant differences in mortality, failure-to-rescue, and cost.
Matching can produce fair, directly standardized audits. From the perspective of the index hospital, "hospital-specific" template matching provides the fairness of direct standardization with the specific institutional relevance of indirect standardization. Using this approach, hospitals will be better able to examine their performance, and better determine why they are achieving the results they observe.
开发一种改进的医院成本和质量审核方法，以适应特定医院的患者群体。
数据来源/设置：2004 年至 2006 年期间，来自伊利诺伊州、纽约州和德克萨斯州的医疗保险索赔、妇科和泌尿科手术以及骨科。
从一家单一的索引医院构建了 300 名代表性患者的模板，并将其用于在 43 家至少有 500 名患者的医院中匹配 300 名患者。
数据收集/提取方法：从 43 家医院中，我们使用多元匹配选择了 300 名最类似于模板的患者。
我们发现手术和患者特征的匹配非常接近，比随机试验中预期的要平衡得多。索引医院模板和 43 家医院之间在大多数患者特征上几乎没有差异，但在死亡率、抢救失败和成本方面存在显著差异。
匹配可以产生公平的直接标准化审核。从索引医院的角度来看，“医院特定”的模板匹配提供了直接标准化的公平性，同时具有间接标准化的特定机构相关性。通过这种方法，医院将能够更好地检查其绩效，并更好地确定为什么他们能够实现所观察到的结果。
