Using a hierarchical model to estimate risk-adjusted mortality for hospitals not included in the reference sample
- Health Services Research, 45, 577-587
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 to 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.
- Number of levels
- Model data structure
- Response types
- Multivariate response model?
- Longitudinal data?
- Substantive discipline
- Paper submitted by
- David Clark, Center for Outcomes Research and Evaluation, Maine Medical Center, email@example.com