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FWIW local demographics have a non-negligible effect on a hospital's specialty. The nearest hospital to a retirement community will get more practice at heart attacks and strokes and the one in the college town will be good at dealing with alcohol poisoning.

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from the abstract:

Risk-adjusted outcomes were calculated after adjusting for population factors, co-morbidities, and health system factors. Even after risk-adjustment, there exists large geographical variation in outcomes

That means they adjust for things like that heart attacks in 80-year-olds are more likely fatal than in 40-year-olds, so a hospital serving mostly the former is expected to have a lower survival rate for heart attack patients.

They are trying to measure differences in effectiveness for similar patients. GP gives a possible explanation for such a difference : the hospital probably gets good at the kinds of things it does a lot.

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