• Jeffrey H Silber, Paul R Rosenbaum, Richard N Ross, Justin M Ludwig, Wei Wang, Bijan A Niknam, 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): 1475-97.

ObjectiveDevelop an improved method for auditing hospital cost and quality tailored to a specific hospital's patient population.Data Sources/SettingMedicare claims in general, gynecologic and urologic surgery, and orthopedics from Illinois, New York, and Texas between 2004 and 2006.Study DesignA 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 MethodsFrom each of 43 hospitals we chose 300 patients most resembling the template using multivariate matching.Principal FindingsWe 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.ConclusionMatching 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.© Health Research and Educational Trust.

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