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Abstract:
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Hospital-specific template matching is an approach to hospital benchmarking that compares performance between peer hospitals for similar patients. The number of comparator hospitals may differ for each hospital, yielding potentially uneven power. Our objective was to assess the statistical power of hospital-specific template matching to detect mortality differences within the Veterans Affairs Health System (VA). We used VA EHR data for 556,266 hospitalizations at 122 hospitals. We randomly selected a template of 500 hospitalizations from each hospital. We matched patients at the remaining 121 hospitals on demographics, diagnoses, and acute physiology to each hospital template. Hospitals were compared on mortality rates in their template to matched hospitalizations from comparator hospitals. We used simulation to quantify the power to detect a variety of standardized mortality ratios (SMR) for hospitals with few, average, or many comparison hospitals. Power to detect an SMR of 2 ranged from 66% for a hospital with few comparisons to 75% for a hospital with many comparisons. Although the number of matches varied substantially (5 to 60), the impact to power was relatively minor.
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