Estimating surgical volume—outcome relationships applying survival models: accounting for frailty and hospital fixed effects
✍ Scribed by Barton H. Hamilton; Vivian H. Hamilton
- Publisher
- John Wiley and Sons
- Year
- 1997
- Tongue
- English
- Weight
- 153 KB
- Volume
- 6
- Category
- Article
- ISSN
- 1057-9230
No coin nor oath required. For personal study only.
✦ Synopsis
This paper investigates the surgical volume-outcome relationship for patients undergoing hip fracture surgery in Quebec between 1991 and 1993. Using a duration model with multiple destinations which accounts for observed and unobserved (by the researcher) patient characteristics, our initial estimates show that higher surgical volume is associated with a higher conditional probability of live discharge from the hospital. However, these results reflect differences between hospitals rather than differences within hospitals over time: when we also control for differences between hospitals that are fixed over time, hospitals performing more surgeries in period t + 1 than in period t experience no significant change in outcomes, as would be predicted by the 'practice makes perfect' hypothesis. The volume-outcome relationship for hip fracture patients thus appears to reflect quality differences between high and low volume hospitals.