Personalized Health Care Outcome Analysis of Cardiovascular Surgical Procedures
34 Pages Posted: 31 Dec 2016 Last revised: 20 Apr 2021
Date Written: April 18, 2021
This study addresses three important questions concerning personalized health care: (1) Are outcome differences between hospitals heterogeneous across patients? (2) If they are, how valuable is patient-centric information (that accounts for heterogeneity) to patients in selecting a hospital? and (3) What impact would patient-centric information have on pay-for-performance systems in which hospitals’ reimbursements are based on patients’ outcome metrics? Using patient-level data from 35 hospitals for six cardiovascular surgeries in New York State, we identify patient groups that exhibit significant differences in outcomes with a recently developed instrumental variable tree approach. We find outcome differences between hospitals are heterogeneous not only across procedure types, but also along other dimensions such as patient age and comorbidities. For around 80% of patients, the best-quality hospitals indicated by patient-centric information are different from those indicated as best by population-average information. We compare potential outcomes when patients are treated at the best-quality hospitals based on the two types of information, and estimate complications could be reduced by 66.7% by using patient-centric information instead of population-average information. We also use our model to illustrate how patient-centric information can enhance pay-for-performance programs offered by payers and guide hospitals in targeting quality-improvement efforts.
Keywords: Healthcare outcome analysis, patient-centric healthcare, provider quality, machine learning
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