Estimating surgical volume-outcome relationships applying survival models: accounting for frailty and hospital fixed effects
Barton Hamilton () and
Vivian H. Hamilton
Authors registered in the RePEc Author Service: Vivian Ho ()
Health Economics, 1997, vol. 6, issue 4, 383-395
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. © 1997 John Wiley & Sons, Ltd.
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Persistent link: https://EconPapers.repec.org/RePEc:wly:hlthec:v:6:y:1997:i:4:p:383-395
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