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Inference for Identifying Outlying Health Care Providers

*Michael Joseph Racz, Albany College of Pharmacy and Health Sciences 
Joe Sedransk, Case Western Reserve University 

Keywords: Coronary artery bypass graft surgery, credible regions, posterior predictive p-value

Provider profiling is the evaluation of the performance of hospitals, doctors, and other medical practitioners to enhance the quality of care. Many jurisdictions have released public report cards comparing hospital or physician-specific outcomes. Ohlssen, Sharples, and Spiegelhalter present an extensive evaluation of provider profiling methodology. In particular, they are concerned about whether a putative outlier is really an outlier or an observation in the tail of the common distribution for all practitioners and present methodology to address this issue. Using both New York State bypass surgery data and simulated data of the same type, we evaluate the Ohlssen et al. approach, comparing it with results from applying standard methodology. We also present and evaluate a third method. Here, a 100(1 - a)% credible region is developed for the provider fixed effects and used to identify outliers.