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. 2010 Apr;45(2):577-87.
doi: 10.1111/j.1475-6773.2009.01074.x. Epub 2010 Jan 8.

Using a hierarchical model to estimate risk-adjusted mortality for hospitals not included in the reference sample

David E Clark  1 , Edward L Hannan, Stephen W Raudenbush
Affiliations

Using a hierarchical model to estimate risk-adjusted mortality for hospitals not included in the reference sample

David E Clark et al. Health Serv Res. 2010 Apr.

Abstract

Objective: To provide a method for any hospital to evaluate patient mortality using a hierarchical risk-adjustment equation derived from a reference sample.

Data source: American College of Surgeons National Trauma Data Bank (NTDB).

Study design: Hierarchical logistic regression models predicting mortality were estimated from NTDB data. Risk-adjusted hospital effects obtained directly from models using standard software were compared with approximations derived from a summary equation and data from each individual hospital.

Principal findings: Theoretical approximations were similar to results using standard software.

Conclusions: To allow independent verification, agencies using reference databases for hospital mortality "report cards" should publish their risk-adjustment equations. Similar hospitals not in the reference database may also use the published equations along with the approximations described to evaluate their own outcomes using their own data.

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