Dataset Information

Template matching for auditing hospital cost and quality.

ABSTRACT:

Objective

Develop an improved method for auditing hospital cost and quality.

Data sources/setting

Medicare claims in general, gynecologic and urologic surgery, and orthopedics from Illinois, Texas, and New York between 2004 and 2006.

Study design

A 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 methods

From each of 217 hospitals we chose 300 patients most resembling the template using multivariate matching.

Principal findings

The 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.

Conclusion

The 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.

SUBMITTER: Silber JH

PROVIDER: S-EPMC4213044 | biostudies-literature | 2014 Oct

REPOSITORIES: biostudies-literature

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Publications

Template matching for auditing hospital cost and quality.

Silber Jeffrey H JH Rosenbaum Paul R PR Ross Richard N RN Ludwig Justin M JM Wang Wei W Niknam Bijan A BA Mukherjee Nabanita N Saynisch Philip A PA Even-Shoshan Orit O Kelz Rachel R RR Fleisher Lee A LA

Health services research 20140303 5

<h4>Objective</h4>Develop an improved method for auditing hospital cost and quality.<h4>Data sources/setting</h4>Medicare claims in general, gynecologic and urologic surgery, and orthopedics from Illinois, Texas, and New York between 2004 and 2006.<h4>Study design</h4>A 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.<h4>Data collection/extraction methods</h4>From each of 217 ho ...[more]

PMID: 24588413

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Project description:How much can we rely on whether what was reported in a study was actually done? Systematic and independent examination of records, documents and processes through audits are a central element of quality management systems. In the context of current concerns about the robustness and reproducibility of experimental biomedical research audits have been suggested as a remedy a number of times. However, audits are resource intense and time consuming, and due to their very nature may be perceived as inquisition. Consequently, there is very little experience or literature on auditing and assessments in the complex preclinical biomedical research environment. To gain some insight into which audit approaches might best suit biomedical research in academia, in this study we have applied a number of them in a typical academic neuroscience environment consisting of twelve research groups with about 100 researchers, students and technicians, utilizing the full gamut of state-of-the-art methodology. Several types of assessments and internal as well as external audits (including the novel format of a peer audit) were systematically explored by a team of quality management specialists. An experimental design template was developed (and is provided here) that takes into account and mitigates difficulties, risks and systematic errors that may occur during the course of a study. All audits were performed according to a pre-defined workflow developed by us. Outcomes were assessed qualitatively. We asked for feedback from participating employees in every final discussion of an audit and documented this in the audit reports. Based on these reports follow-up audits were improved. We conclude that several realistic options for auditing exist which have the potential to improve preclinical biomedical research in academia, and have listed specific recommendations regarding their benefits and provided practical resources for their implementation (e.g. study design and audit templates, audit workflow).

Dataset Information

Template matching for auditing hospital cost and quality.

Objective

Data sources/setting

Study design

Data collection/extraction methods

Principal findings

Conclusion

Publications

Template matching for auditing hospital cost and quality.

Similar Datasets

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