Statistical and clinical aspects of hospital outcomes profiling

Abstract. Hospital profiling involves a comparison of a health care provi-der’s structure, processes of care, or outcomes to a standard, often in the form of a report card. Given the ubiquity of report cards and similar con-sumer ratings in contemporary American culture, it is notable that these are a relatively recent phenomenon in health care. Prior to the 1986 release of Medicare hospital outcome data, little such information was publicly avail-able. We review the historical evolution of hospital profiling with special emphasis on outcomes; present a detailed history of cardiac surgery report cards, the paradigm for modern provider profiling; discuss the potential un-intended negative consequences of public report cards; and describe various statistical methodologies for quantifying the relative performance of cardiac surgery programs. Outstanding statistical issues are also described. Key words and phrases: Mortality, report cards, quality of care, variations, risk adjustment, hierarchical models, profiling, evidence-based medicine, se-lection bias