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Kimon Bekelis, Daniel J. Gottlieb, Yin Su, A. James O'Malley, Nicos Labropoulos, Philip Goodney, Michael T. Lawton and Todd A. MacKenzie

effects methods to control for clustering at the hospital referral region (HRR) level. To control for unmeasured confounding, we used an instrumental variable (IV) approach, creating pseudo-randomization on the treatment method. Methods Data and Cohort Creation The Dartmouth Committee for the Protection of Human Subjects approved this study. Data were anonymized and de-identified prior to use; therefore, no informed consent was required. We used 100% of the Medicare Denominator File and corresponding Medicare inpatient and outpatient claims, Parts A and B, for