title: Benchmarking hospital outcomes for improvement of care in Medicare elective colon surgery.
abstract: BACKGROUND
  Risk-adjusted outcomes are essential for hospitals to benchmark care improvement.
  
  
  METHODS
  We used the Medicare Limited Data Set for 2010 to 2012 to create risk models in elective colon surgery for the adverse outcomes (AOs) of inpatient deaths, prolonged length-of-stay outliers, 90-day post-discharge deaths without readmission, and 90-day relevant readmissions. Risk models permitted the prediction of AOs for each hospital and the design of hospital-specific standard deviations (SDs) to define performance from observed values. Risk-adjusted AO rates were computed for hospital comparisons.
  
  
  RESULTS
  In all, 1,903 hospitals with 129,861 patients were studied. Overall AO rate was 27.8%; 84 hospitals had AO performance that was 2 SDs poorer than average and 66 were 2 SDs better. The top performing decile of hospitals had a risk-adjusted AO rate of 15.8%, whereas the lowest performing hospital's rate was 39.4%.
  
  
  CONCLUSIONS
  Benchmarking risk-adjusted AOs identifies the opportunity for care improvement in elective colon surgery in Medicare patients.
authors.affiliation: MPA Healthcare Solutions, 1 East Wacker Drive #1210, Chicago, IL 60601, USA; Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; The Department of Surgery, University of New Mexico School of Medicine, Albuquerque, NM, USA. Electronic address: dfry@consultmpa.com.
authors.forename: Donald E
authors.initials: DE
authors.lastname: Fry
authors.affiliation: MPA Healthcare Solutions, 1 East Wacker Drive #1210, Chicago, IL 60601, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Pine
authors.affiliation: MPA Healthcare Solutions, 1 East Wacker Drive #1210, Chicago, IL 60601, USA; Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Nedza
authors.affiliation: MPA Healthcare Solutions, 1 East Wacker Drive #1210, Chicago, IL 60601, USA.
authors.forename: David G
authors.initials: DG
authors.lastname: Locke
authors.affiliation: MPA Healthcare Solutions, 1 East Wacker Drive #1210, Chicago, IL 60601, USA.
authors.forename: Agnes M
authors.initials: AM
authors.lastname: Reband
authors.affiliation: MPA Healthcare Solutions, 1 East Wacker Drive #1210, Chicago, IL 60601, USA.
authors.forename: Gregory
authors.initials: G
authors.lastname: Pine
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019985:Benchmarking; D003107:Colorectal Surgery / Q000379:methods / Q000706:statistics & numerical data*; D016208:Databases, Factual; D017558:Elective Surgical Procedures / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014481:United States
keywords: Colon surgery; Complications of care; Control charts; Postoperative deaths; Readmissions; Risk-adjusted hospital outcomes