Grading Hospitals Using Multivariate Matching.

Background and objectives: To improve upon existing hospital grading systems, we developed a new report card based on multivariate matching.

Research design: Matched cohorts. For each focal hospital patient, we match 10 control patients treated at "well-resourced" hospitals with excellent hospital characteristics from across the nation, and 10 control patients treated at "typical" hospitals, on over 300 patient characteristics from Medicare Claims. Grades were based on outcome differences between patients at the focal hospital and their matched controls. We also create an "Analogous" match that is comprised of multiple control patients matched to each focal hospital patient with similar patient characteristics who were treated at hospitals with similar characteristics to the focal hospital, answering the question, "How would patients who looked like my patients and who were treated at hospitals like my hospital fare, compared to how my patients fared." We also report outcomes by multimorbidity status.

Subjects: Medicare admissions from 2017 to 2019 for heart attack, heart failure and pneumonia. To illustrate our methods, we report on 4 hospitals in the same region: a well-known "Flagship" teaching Hospital, an Affiliated Hospital within the same flagship system, a Poor-Performing Hospital that is not part of the flagship system, and a Small Hospital with unstable estimates.

Measures: Thirty-day mortality and revisit rates.

Results: Report cards for each example hospital.

Conclusions: Matched report cards allow users to better benchmark hospitals and see those types of patients where a specific hospital is performing poorly compared to other hospitals treating very similar patients.