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Developing a template matching algorithm for benchmarking hospital performance in a diverse, integrated healthcare
Daniel Molling1, Brenda M Vincent1, Wyndy L Wiitala1
1VA Center for Clinical Management Research, Ann Arbor, MI.
Medicine
|June 17, 2020
Summary
Template matching for hospital benchmarking is not feasible due to significant case-mix variation across Veterans Affairs (VA) hospitals. A single template cannot balance all patient characteristics for accurate performance measurement.
Area of Science:
- Health Services Research
- Health Informatics
- Hospital Administration
Background:
- Hospital benchmarking is crucial for performance evaluation and quality improvement.
- Template matching offers a potential method for comparing hospital performance using matched patient cohorts.
- Assessing the feasibility of template matching in diverse healthcare systems is essential.
Purpose of the Study:
- To evaluate the feasibility of template matching for benchmarking hospital performance within the Veterans Affairs (VA) healthcare system.
- To determine if a standardized template can adequately balance patient characteristics across diverse VA hospitals.
- To identify limitations of template matching in the context of significant case-mix variation.
Main Methods:
- An observational cohort study using administrative and clinical data from 668,592 hospitalizations at 134 VA hospitals in 2017.
- A standardized template of 300 hospitalizations was created.
- 300 hospitalizations were matched to the template from each hospital using various algorithms.
Main Results:
- Substantial case-mix variation (e.g., age, surgical admissions, emergency department use, patient ethnicity) persisted across VA hospitals.
- Matching algorithms could not balance all measured characteristics simultaneously, with a maximum of ~20 variables balanced.
- Significant variation in key patient demographics and admission types limited the effectiveness of template matching.
Conclusions:
- Template matching, using a single standardized template, is likely not feasible for general hospital benchmarking in diverse systems like the VA.
- The significant and persistent case-mix variation across hospitals poses a major challenge to this benchmarking approach.
- Alternative or refined methods are needed for effective hospital performance benchmarking in heterogeneous healthcare settings.
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