title: Indirect Standardization Matching: Assessing Specific Advantage and Risk Synergy.
abstract: OBJECTIVE
  To develop a method to allow a hospital to compare its performance using its entire patient population to the outcomes of very similar patients treated elsewhere.
  
  
  METHODS
  Medicare claims in orthopedics and common general, gynecologic, and urologic surgery from Illinois, New York, and Texas from 2004 to 2006.
  
  
  METHODS
  Using two example "focal" hospitals, each hospital's patients were matched to 10 very similar patients selected from 619 other hospitals.
  
  
  METHODS
  All patients were used at each focal hospital, and we found the 10 closest matched patients from control hospitals with exactly the same principal procedure as each focal patient.
  
  
  RESULTS
  We achieved exact matches on all procedures and very close matches for other patient characteristics for both hospitals. There were few to no differences between each hospital's patients and their matched control patients on most patient characteristics, yet large and significant differences were observed for mortality, failure-to-rescue, and cost.
  
  
  CONCLUSIONS
  Indirect standardization matching can produce fair audits of quality and cost, allowing for a comprehensive, transparent, and relevant assessment of all patients at a focal hospital. With this approach, hospitals will be better able to benchmark their performance and determine where quality improvement is most needed.
authors.affiliation: Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, PA.|The Department of Pediatrics, The University of Pennsylvania School of Medicine, Philadelphia, PA.|Department of Anesthesiology and Critical Care, The University of Pennsylvania School of Medicine, Philadelphia, PA.|Department of Health Care Management, The Wharton School, The University of Pennsylvania, Philadelphia, PA.|The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA.
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Silber
authors.affiliation: The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA.|Department of Statistics, The Wharton School, The University of Pennsylvania, Philadelphia, PA.
authors.forename: Paul R
authors.initials: PR
authors.lastname: Rosenbaum
authors.affiliation: Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, PA.
authors.forename: Richard N
authors.initials: RN
authors.lastname: Ross
authors.affiliation: Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, PA.
authors.forename: Justin M
authors.initials: JM
authors.lastname: Ludwig
authors.affiliation: Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, PA.
authors.forename: Wei
authors.initials: W
authors.lastname: Wang
authors.affiliation: Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, PA.
authors.forename: Bijan A
authors.initials: BA
authors.lastname: Niknam
authors.affiliation: Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, PA.
authors.forename: Alexander S
authors.initials: AS
authors.lastname: Hill
authors.affiliation: Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, PA.|The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA.
authors.forename: Orit
authors.initials: O
authors.lastname: Even-Shoshan
authors.affiliation: The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA.|Department of Surgery, The University of Pennsylvania School of Medicine, Philadelphia, PA.
authors.forename: Rachel R
authors.initials: RR
authors.lastname: Kelz
authors.affiliation: Department of Anesthesiology and Critical Care, The University of Pennsylvania School of Medicine, Philadelphia, PA.|The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA.
authors.forename: Lee A
authors.initials: LA
authors.lastname: Fleisher
mesh_terms: D019985:Benchmarking / Q000379:methods; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D007087:Illinois; D006278:Medicare / Q000706:statistics & numerical data*; D015233:Models, Statistical; D009518:New York; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data / Q000639:trends*; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D012306:Risk; D013781:Texas; D014481:United States
keywords: Quality of care; cost; health care research; outcomes research