Hierarchical Generalized Linear Models in the Analysis of Variations in Health Care Utilization

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Abstract
In recent years many studies have reported large differences in the use of medical treatments and procedures across geographic regions, hospitals, and individual health care providers. Beyond reporting on the extent of observed variations, these studies examine the role of contributing factors including patient, regional, and provider characteristics. In addition, they may assess the relation between health care processes and outcomes, such as patient mortality, morbidity, and functioning. Studies of variations in health care utilization and outcomes involve the analysis of multilevel clustered data; for example, data on patients clustered by hospital and/or geographic region. The goals of the analysis include the estimation of cluster-specific adjusted responses, covariate effects, and components of variance. The analytic strategy needs to account for correlations induced by clustering and to handle the presence of large variations in cluster size. In this article we formulate a broad class of h...

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