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Bilimoria KY, Cohen ME, Merkow RP, Wang X, Bentrem DJ, Ingraham AM, Richards K, Hall BL, Ko CY. Comparison of outlier identification methods in hospital surgical quality improvement programs. Journal of Gastrointestinal Surgery : Official Journal of The Society For Surgery of The Alimentary Tract. 2010 Oct 1; 14(10):1600-7.
There was considerable variation in the number of outliers identified using different detection approaches. Quality programs seem to be utilizing outlier identification methods contrary to what might be expected, thus they should justify their methodology based on the intent of the program (i.e., quality improvement vs. reimbursement). Surgeons and hospitals should be aware of variability in methods used to assess their performance as these outlier designations will likely have referral and reimbursement consequences.