A frontier analysis approach for benchmarking hospital performance in the treatment of acute myocardial infarction

This paper uses a non-parametric frontier model and adaptations of the concepts of cross-efficiency and peer-appraisal to develop a formal methodology for benchmarking provider performance in the treatment of Acute Myocardial Infarction (AMI). Parameters used in the benchmarking process are the rates of proper recognition of indications of six standard treatment processes for AMI; the decision making units (DMUs) to be compared are the Medicare eligible hospitals of a particular state; the analysis produces an ordinal ranking of individual hospital performance scores. The cross-efficiency/peer-appraisal calculation process is constructed to accommodate DMUs that experience no patients in some treatment categories. While continuing to rate highly the performances of DMUs which are efficient in the Pareto-optimal sense, our model produces individual DMU performance scores that correlate significantly with good overall performance, as determined by a comparison of the sums of the individual DMU recognition rates for the six standard treatment processes. The methodology is applied to data collected from 107 state Medicare hospitals.