Table 2.
Auditing Hospital A’s Outcomes. We present a profile of Hospital A to illustrate the audit results. For each outcome we examine how Hospital A performed versus the 43 other hospitals on sets of matched patients that were very similar to those seen at Hospital A. We then examined for each outcome the orthopedic surgery and general surgery patients in the 43 hospitals not including Hospital A, to study how Hospital A fared in these patients undergoing different types of surgery. Letters denote p-values for comparing Hospital A to the 43 other hospitals. Percentile ranks (1 = best, 100 = worst)
| All Patients | Orthopedic Surgery Patients | General Surgery Patients | |||||||
|---|---|---|---|---|---|---|---|---|---|
| Outcomes (Percent Unless Otherwise Noted) | Hospital A N = 300 | 43 Other Hospitals N = 12,900 | Hospital A N = 150 | 43 Other Hospitals N = 6,450 | Hospital A N = 150 | 43 Other Hospitals N = 6,450 | |||
| % or Mean | Percentile | % or Mean | Percentile | % or Mean | Percentile | ||||
| Mortality | |||||||||
| Inpatient | 4.0***,†††† | 97 | 1.5 | 1.3 | 74 | 0.8 | 6.7****,†††† | 97 | 2.2 |
| 30-day | 5.3***,†††† | 97 | 2.3 | 2.0 | 66 | 1.8 | 8.7****,†††† | 97 | 2.9 |
| Complications | |||||||||
| Inpatient | 44.3 | 74 | 41.6 | 40.0 | 52 | 41.9 | 48.7* | 91 | 41.2 |
| 30-day | 51.7 | 33 | 55.4 | 48.0**,†† | 21 | 58.9 | 55.3 | 72 | 51.8 |
| FTR | |||||||||
| Inpatient | 9.0***,††† | 97 | 3.7 | 3.3 | 76 | 2.0 | 13.7***,†††† | 97 | 5.4 |
| 30-day | 10.3***,†††† | 97 | 4.4 | 4.2 | 80 | 3.0 | 15.7****,†††† | 97 | 5.8 |
| Readmissions | |||||||||
| 30-day | 10.3 | 77 | 8.9 | 10.0 | 74 | 8.2 | 10.7 | 70 | 9.6 |
| Total cost ($k) | |||||||||
| Inpatient | 11.7 | 52 | 11.7 | 10.2***,†† | 17 | 11.1 | 15.8**,††† | 93 | 13.0 |
| 30-day | 13.0 | 73 | 12.6 | 10.9**,† | 26 | 11.7 | 17.3**,††† | 93 | 14.1 |
| Total payment ($k) | |||||||||
| Inpatient | 13.4****,†††† | 28 | 15.2 | 13.7****,†††† | 20 | 15.8 | 12.2**,† | 42 | 13.1 |
| 30-day | 13.9****,†††† | 31 | 15.8 | 14.0****,†††† | 20 | 16.2 | 13.5**,† | 44 | 14.2 |
| Length of stay | |||||||||
| Overall | 4.5 | 31 | 4.7 | 4.1 | 40 | 4.4 | 5.1 | 52 | 5.1 |
| % of patients sent to ICU | 27.0****,†††† | 88 | 15.3 | 10.7 | 72 | 8.5 | 43.3****,†††† | 95 | 22.1 |
| Days in ICU, if sent to ICU‡ | 7.3† | 90 | 6.0 | 3.3 | 34 | 4.9 | 8.3†† | 95 | 6.5 |
| Procedure time (minutes) | 150.0****,†††† | 71 | 141.4 | 142.5 | 68 | 140.7 | 165.8****,†††† | 88 | 144.6 |
| Balance of Matched Variables | |||||||||
|---|---|---|---|---|---|---|---|---|---|
| Age (mean, years) | 76.3 | 76.0 | 77.2 | 76.8 | 75.5 | 75.2 | |||
| Gender (% male) | 42.7 | 42.2 | 37.3 | 36.7 | 48.0 | 47.6 | |||
| Procedure time (predicted) | 138.6 | 138.2 | 137.3 | 137.5 | 139.9 | 138.9 | |||
| Probability of 30-day death | 0.025 | 0.026 | 0.017 | 0.020 | 0.033 | 0.033 | |||
| Emergency admission | 16.0 | 16.5 | 16.7 | 17.3 | 15.3 | 15.8 | |||
| Transfer-in | 5.7 | 5.1 | 4.0 | 3.7 | 7.3 | 6.4 | |||
| Hx CHF | 17.0 | 16.7 | 14.7 | 14.3 | 19.3 | 19.1 | |||
| Hx arrhythmia | 23.0 | 22.8 | 18.7 | 18.5 | 27.3 | 27.0 | |||
| Hx MI | 11.3 | 10.4 | 11.3 | 10.2 | 11.3 | 10.6 | |||
| Hx angina | 4.0 | 3.8 | 2.7 | 2.7 | 5.3 | 4.9 | |||
| Hx diabetes | 27.0 | 26.4 | 22.7 | 22.2 | 31.3 | 30.6 | |||
| Hx renal dysfunction | 6.0 | 6.3 | 2.7 | 3.5 | 9.3 | 9.1 | |||
| Hx COPD | 17.3 | 17.4 | 12.0 | 12.5 | 22.7 | 22.4 | |||
| Hx of asthma | 14.3 | 13.4 | 12.7 | 11.6 | 16.0 | 15.1 | |||
Note. Mantel–Haenszel (binary variables) or stratified Wilcoxon rank-sum (continuous variables) p-value key: *p < .05; **p < .01; ***p < .001; ****p < .0001.
Conditional logit (binary variables) or m-estimation (continuous variables) p-value key: †p < .05; ††p < .01; †††p < .001; ††††p < .0001.
Conditional logit and m-estimation p-values account for paired differences in probability of death, predicted procedure time, transfer-in status, and emergency status. Length of stay means were calculated using trimmed means, excluding 2.5% of patients from each extreme. Total costs and payments are reported using Hodges–Lehmann estimates.
Tests for differences in days in ICU, if sent to ICU, are not paired due to the nature of the variable.