Hospital-specific Template Matching for Benchmarking Performance in a Diverse Multihospital System.
Hospital-specific Template Matching for Benchmarking Performance in a Diverse Multihospital System.
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DOI：
10.1097/mlr.0000000000001645
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发表时间：
2021-12-01
期刊：
影响因子：
3
通讯作者：
Prescott HC
中科院分区：
文献类型：
--
作者：
Vincent BM;Molling D;Escobar GJ;Hofer TP;Iwashyna TJ;Liu VX;Rosen AK;Ryan AM;Seelye S;Wiitala WL;Prescott HC
医院特定模板匹配是一种较新的医院绩效测量方法，可能比基于回归的基准测试更公平。然而，它只在有限的研究环境中进行了测试。在退伍军人事务部（VA）医疗保健系统中测试医院特定模板匹配评估的可行性，并确定检测超出预期的30天死亡率的功效。采用医院特异性模板匹配评估的观察性队列研究。对于每家VA医院，将代表性住院子集的30天死亡率与治疗充分相似患者的一组比较VA医院匹配住院的汇总死亡率进行比较。模拟用于确定检测高于预期死亡率的把握度。2017年在122家VA医院住院556，266人。每家医院确定的比较医院数量; 30天死亡率。每家医院的中位数为38家比较医院（四分位距：33，44），116家（95.1%）至少有20家比较医院。总体而言，8家医院（6.6%）的30天死亡率显著低于基准，5家医院（4.1%）的30天死亡率显著高于基准，其余109家医院（89.3%）与基准相似。检测标准化死亡率为2.0的能力范围为72.5%-79.4%，比较医院最少（6家）与最多（64家）。医院特定的模板匹配可能是可行的，在不同的VA医疗保健系统中评估医院的性能，但需要进一步完善，以优化操作使用前的方法。我们的研究结果可能适用于其他大型和多样化的多医院系统。
Hospital-specific template matching is a newer method of hospital performance measurement that may be fairer than regression-based benchmarking. However, it has been tested in only limited research settings. To test the feasibility of hospital-specific template matching assessments in the Veterans Affairs (VA) healthcare system and determine power to detect greater-than-expected 30-day mortality. Observational cohort study with hospital-specific template matching assessment. For each VA hospital, 30-day mortality of a representative subset of hospitalizations was compared to the pooled mortality from matched hospitalizations at a set of comparison VA hospitals treating sufficiently similar patients. Simulation was used to determine power to detect greater-than-expected mortality. 556,266 hospitalizations at 122 VA hospitals in 2017. Number of comparison hospitals identified per hospital; 30-day mortality. Each hospital had a median of 38 comparison hospitals (interquartile range: 33, 44) identified, and 116 (95.1%) had at least 20 comparison hospitals. In total, 8 hospitals (6.6%) had a significantly lower 30-day mortality than their benchmark, 5 hospitals (4.1%) had a significantly higher 30-day mortality, and the remaining 109 hospitals (89.3%) were similar to their benchmark. Power to detect a standardized mortality ratio of 2.0 ranged from 72.5%-79.4% for a hospital with the fewest (6) versus most (64) comparison hospitals. Hospital-specific template matching may be feasible for assessing hospital performance in the diverse VA healthcare system, but further refinements are needed to optimize the approach before operational use. Our findings are likely applicable to other large and diverse multi-hospital systems.