Volume 51 | Number S2 | June 2016

Abstract List

Jeffrey H. Silber M.D., Ph.D., Ville A. Satopää B.A., Nabanita Mukherjee Ph.D., Veronika Rockova Ph.D., Wei Wang Ph.D., Alexander S. Hill B.S., Orit Even‐Shoshan M.S., Paul R. Rosenbaum Ph.D., Edward I. George Ph.D.


To improve the predictions provided by Medicare's Hospital Compare () to facilitate better informed decisions regarding hospital choice by the public.

Data Sources/Setting

Medicare claims on all patients admitted for Acute Myocardial Infarction between 2009 through 2011.

Study Design

Cohort analysis using a Bayesian approach, comparing the present assumptions of (using a constant mean and constant variance for all hospital random effects), versus an expanded model that allows for the inclusion of hospital characteristics to permit the data to determine whether they vary with attributes of hospitals, such as volume, capabilities, and staffing. Hospital predictions are then created using directly standardized estimates to facilitate comparisons between hospitals.

Data Collection/Extraction Methods

Medicare fee‐for‐service claims.

Principal Findings

Our model that included hospital characteristics produces very different predictions from the current model, with higher predicted mortality rates at hospitals with lower volume and worse characteristics. Using Chicago as an example, the expanded model would advise patients against seeking treatment at the smallest hospitals with worse technology and staffing.


To aid patients when selecting between hospitals, the Centers for Medicare and Medicaid Services (CMS) should improve the model by permitting its predictions to vary systematically with hospital attributes such as volume, capabilities, and staffing.