Citation: Romley, J., Trish, E., Goldman, D., Buntin, M. B., He, Y., & Ginsburg, P. (2019). Geographic variation in the delivery of high-value inpatient care. PLoS One, 14(3).
John Romley and his colleagues leveraged measures of quality in care delivery and cost to determine a value index score, and uses this score to measure variation in the value of inpatient care across U.S. regions. Using Medicare claims and enrollment forms, linked to the Dartmouth Atlas of Health Care and Inpatient Prospective Payment System Impact Files, Schaeffer Center researchers estimate a production function for inpatient care, defining output as stays with favorable patient outcomes in terms of survival and readmission. The regression model includes hospital inputs measured by treatment costs, as well as patient characteristics. Region-level effects in the production function are used to estimate the productivity and value of the care delivered by hospitals within regions. Hospitals in the hospital referral region at the 90th percentile of the value distribution delivered 54 percent more high-quality stays than hospitals at the 10th percentile could have delivered, after adjusting for treatment costs and patient severity. Variation in the delivery of high-value inpatient care points to opportunities for better quality and lower costs.