Medical profiling: improving standards and risk adjustments using hierarchical models

J Health Econ. 2000 May;19(3):291-309. doi: 10.1016/s0167-6296(99)00034-x.


The conclusions from a profile analysis to identify performance extremes can be affected substantially by the standards and statistical methods used and by the adequacy of risk adjustment. Medically meaningful standards are proposed to replace common statistical standards. Hierarchical regression methods can handle several levels of random variation, make risk adjustments for the providers' case-mix differences, and address the proposed standards. These methods determine probabilities needed to make meaningful profiles of medical units based on standards set by all appropriate parties.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Hospitals, Veterans / statistics & numerical data
  • Intensive Care Units / statistics & numerical data
  • Models, Statistical*
  • Patient Readmission / statistics & numerical data
  • Poisson Distribution
  • Quality Assurance, Health Care / organization & administration*
  • Quality Assurance, Health Care / statistics & numerical data
  • Risk Adjustment / methods
  • Risk Adjustment / statistics & numerical data*