• Ruth E Wachtel, Franklin Dexter, Brian Barry, and Carol Applegeet.
• Department of Anesthesia, University of Iowa, Iowa City, IA 52242, USA.
• Anesth. Analg. 2010 Apr 1;110(4):1146-54.

IntroductionA hospital or anesthesia or surgical group that is making decisions to expand its practice benefits from knowledge of the types of surgical procedures performed at other hospitals.MethodsDischarge abstract data were used to study 1 hospital in each of 3 states. A similarity index provided information on which other hospitals in each state were competitors and/or peer institutions. To reveal potential growth opportunities, Clinical Classifications Software (CCS) grouping of specific types of procedures into broad categories was combined with the similarity index. The internal Herfindahl index was used to quantify the heterogeneity of procedures within each CCS category.ResultsAlthough the similarity index between many pairs of hospitals was highly influenced by the common orthopedic procedures performed at most hospitals, the similarity index was dominated by a large number of different types of procedures. For some pairs of hospitals, there was considerable overlap between the different types of procedures performed at each institution. For other pairs of hospitals, the overlap was small. Consequently, large hospitals were not always similar to each other because of the wide range of procedures performed. Smaller community hospitals were not always similar to each other either. Some small hospitals were sometimes similar to large metropolitan hospitals.ConclusionsThe similarity index is a robust and valid method for quantitatively comparing the numbers and types of inpatient surgical procedures performed at different hospitals. The similarity index, when combined with CCS categories, is useful for identifying opportunities that enable surgeons and anesthesiologists to better meet the needs of their communities.

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