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Activity Number: 428 - Recent Advances in Statistical Methods for Healthcare Provider Profiling
Type: Invited
Date/Time: Thursday, August 6, 2020 : 10:00 AM to 11:50 AM
Sponsor: ENAR
Abstract #309174
Title: Indirect and Direct Standardization of Medical Provider Mortality Ratios
Author(s): John Kalbfleisch* and Kevin He and Sehee Kim and xuemei Ding
Companies: University of Michigan and University of Michigan and University of Michigan and University of Michigan
Keywords: profiling medical providers; Cox model; Standardized mortality ratio

Monitoring health providers for mortality is important, and quality measures based on indirect and direct standardization have been proposed, with an ongoing debate as to which standardization method is more appropriate. It has been argued that provider-specific indirect standardized estimators should not be compared with one another, because each provider’s indirect standardized measure is adjusted to a different (provider-specific) covariate distribution. Based on a Cox model for covariate adjustment and provider effects, we propose a new approach to estimate a standardized mortality ratio based on indirect standardization (i.e. the observed number of deaths divided by an expected number under a national norm). We show that this measure is also a direct standardized measure provided the national norm is chose in a particular way. For this approach, the perceived disadvantage for ranking of indirect standardization disappears. We assess finite-sample properties by simulation and apply the methods to US kidney transplant data. We also consider generalizations that allow for a time varying provider risk.

Authors who are presenting talks have a * after their name.

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