Inference for Identifying Outlying Health Care Providers

• Activity Number: 83
• Type: Contributed
• Date/Time: Sunday, July 29, 2012 : 4:00 PM to 5:50 PM
• Sponsor: Health Policy Statistics Section
• Author(s): Michael Racz*+
• Companies: Albany College of Pharmacy and Health Sciences
• Keywords: Coronary artery bypass graft surgery ; credible regions ; posterior predictive p-value

Abstract

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. Given the importance of provider profiling, studying the methodology used and providing enhancements is essential. Ohlssen, Sharples and Spiegelhalter (2007) present an extensive, thoughtful 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 as that used in Racz and Sedransk (2010), we evaluate the Ohlssen et al. [1] 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.