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Updated: Jun 17, 2026

An R-Based Landscape Validation of a Competing Risk Model
Published on: September 16, 2022
Using a hierarchical model to estimate risk-adjusted mortality for hospitals not included in the reference sample
David E Clark1, Edward L Hannan, Stephen W Raudenbush
1Department of Surgery, Maine Medical Center, 887 Congress Street, Suite 210, Portland, ME 04102, USA.
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 with 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.
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