Empirical Bayes methods for estimating hospital‐specific mortality rates
- 15 May 1994
- journal article
- research article
- Published by Wiley in Statistics in Medicine
- Vol. 13 (9), 889-903
- https://doi.org/10.1002/sim.4780130902
Abstract
We present alternative methods for estimating hospital-level mortality rates to those used by the Health Care Finance Administration for Medicare patients. We use an empirical Bayes model to represent the different sources of variation in observed hospital-specific mortality rates and we use a logistic regression model to adjust for severity differences (in patient mix) across hospitals. In addition to providing a principled derivation of a standard error for the commonly used estimator, our fully model-based formulation produces much more accurate estimates and resolves the severe problem of multiple comparisons that arises when extreme estimates are used to identify exceptional hospitals. We estimate models for each of four disease conditions using the national Medicare mortality data base which does not contain patient severity descriptors, and mortality data from national samples which do include patient severity descriptors. We find substantial between-hospital variation in the unadjusted death rates from the national data base. Mortality rates differ substantially with patient severity in our models, but the sample sizes are too small to yield reliable estimates of the between-hospital variation in adjusted mortality rates.Keywords
This publication has 26 references indexed in Scilit:
- Laplace expansion for posterior densities of nonlinear functions of parametersBiometrika, 1992
- Changes in quality of care for five diseases measured by implicit review, 1981 to 1986JAMA, 1990
- Studying the effects of the DRG-based prospective payment system on quality of care. Design, sampling, and fieldworkJAMA, 1990
- Sampling-Based Approaches to Calculating Marginal DensitiesJournal of the American Statistical Association, 1990
- Hospital Characteristics and Mortality RatesNew England Journal of Medicine, 1989
- Empirical Bayes Ranking MethodsJournal of Educational Statistics, 1989
- Empirical Bayes Ranking MethodsJournal of Educational Statistics, 1989
- Interpreting hospital mortality data. How can we proceed?Published by American Medical Association (AMA) ,1988
- Predicting the Outcome of Intensive Care Unit PatientsJournal of the American Statistical Association, 1988
- Parametric Empirical Bayes Inference: Theory and ApplicationsJournal of the American Statistical Association, 1983