• Jeffrey H Silber, Paul R Rosenbaum, Richard N Ross, Justin M Ludwig, Wei Wang, Bijan A Niknam, Nabanita Mukherjee, Philip A Saynisch, Orit Even-Shoshan, Rachel R Kelz, and Lee A Fleisher.
• 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 1; 49 (5): 1446-74.

ObjectiveDevelop an improved method for auditing hospital cost and quality.Data Sources/SettingMedicare claims in general, gynecologic and urologic surgery, and orthopedics from Illinois, Texas, and New York between 2004 and 2006.Study DesignA 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 MethodsFrom each of 217 hospitals we chose 300 patients most resembling the template using multivariate matching.Principal FindingsThe 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.ConclusionThe 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.© Health Research and Educational Trust.

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