Statistical Methods for Profiling Providers of Medical Care: Issues and Applications

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Abstract
Recent public debate on costs and effectiveness of health care in the United States has generated a growing emphasis on “profiling” of medical care providers. The process of profiling involves comparing resource use and quality of care among medical providers to a community or a normative standard. This is valuable for targeting quality improvement strategies. For example, hospital profiles may be used to determine whether institutions deviate in important ways in the process of care they deliver. In this article we propose a class of performance indices to profile providers. These indices are based on posterior tail probabilities of relevant model parameters that indicate the degree of poor performance by a provider. We apply our performance indices to profile hospitals on the basis of 30-day mortality rates for a cohort of elderly heart attack patients. The analysis used data from 96 acute care hospitals located in one state and accounted for patient and hospital characteristics using a hierarc...

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