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Estimating surgical volume—outcome relationships applying survival models: accounting for frailty and hospital fixed effects

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  • Barton H. Hamilton
  • Vivian H. Hamilton

Abstract

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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  • Barton H. Hamilton & Vivian H. Hamilton, 1997. "Estimating surgical volume—outcome relationships applying survival models: accounting for frailty and hospital fixed effects," Health Economics, John Wiley & Sons, Ltd., vol. 6(4), pages 383-395, July.
    • Handle: RePEc:wly:hlthec:v:6:y:1997:i:4:p:383-395
    DOI: 10.1002/(SICI)1099-1050(199707)6:4<383::AID-HEC278>3.0.CO;2-L
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    1. Heckman, James & Singer, Burton, 1984. "A Method for Minimizing the Impact of Distributional Assumptions in Econometric Models for Duration Data," Econometrica, Econometric Society, vol. 52(2), pages 271-320, March.
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    Cited by:

    1. Laurent Gobillon & Carine Milcent, 2013. "Spatial disparities in hospital performance," Journal of Economic Geography, Oxford University Press, vol. 13(6), pages 1013-1040, November.
    2. Andrew E. Clark & Carine Milcent, 2008. "Keynesian hospitals? Public employment and political pressure," PSE Working Papers halshs-00586792, HAL.
    3. Hentschker, Corinna & Mennicken, Roman, 2012. "The Relationship between Quality and Hospital Case Volume – An Empirical Examination with German Data," Ruhr Economic Papers 341, RWI - Leibniz-Institut für Wirtschaftsforschung, Ruhr-University Bochum, TU Dortmund University, University of Duisburg-Essen.
    4. Clark, Andrew E. & Milcent, Carine, 2011. "Public employment and political pressure: The case of French hospitals," Journal of Health Economics, Elsevier, vol. 30(5), pages 1103-1112.
    5. Hentschker, Corinna & Mennicken, Roman, 2014. "Selective-referral and unobserved patient heterogeneity - Bias in the volume-outcome relationship," VfS Annual Conference 2014 (Hamburg): Evidence-based Economic Policy 100299, Verein für Socialpolitik / German Economic Association.
    6. Avdic, Daniel & Lundborg, Petter & Vikström, Johan, 2014. "Learning-by-Doing in a Highly Skilled Profession when Stakes are High: Evidence from Advanced Cancer Surgery," Working Paper Series, Center for Labor Studies 2014:9, Uppsala University, Department of Economics.
    7. W. David Bradford & Andrew N. Kleit & Paul J. Nietert & Steven Ornstein, 2010. "The Effect Of Direct To Consumer Television Advertising On The Timing Of Treatment," Economic Inquiry, Western Economic Association International, vol. 48(2), pages 306-322, April.
    8. Andrew Sfekas, 2009. "Learning, forgetting, and hospital quality: an empirical analysis of cardiac procedures in Maryland and Arizona," Health Economics, John Wiley & Sons, Ltd., vol. 18(6), pages 697-711, June.
    9. Woohyeon Kim & Stephen Wolff & Vivian Ho, 2016. "Measuring the Volume-Outcome Relation for Complex Hospital Surgery," Applied Health Economics and Health Policy, Springer, vol. 14(4), pages 453-464, August.
    10. Robin Thompson & Ana Xavier, 2004. "Are Patients in the Transition World Paying Unofficially to Stay Longer in Hospital? Some Evidence from Kazakhstan," LICOS Discussion Papers 14004, LICOS - Centre for Institutions and Economic Performance, KU Leuven.
    11. M. Lippi Bruni & C. Ugolini & R. Verzulli, 2018. "Disentangling the effect of waiting times on hospital choice: Evidence from a panel data analysis," Working Papers wp1118, Dipartimento Scienze Economiche, Universita' di Bologna.
    12. Justin G. Trogdon, 2009. "Demand For And Regulation Of Cardiac Services," International Economic Review, Department of Economics, University of Pennsylvania and Osaka University Institute of Social and Economic Research Association, vol. 50(4), pages 1183-1204, November.
    13. Avdic, Daniel & Lundborg, Petter & Vikström, Johan, 2019. "Estimating returns to hospital volume: Evidence from advanced cancer surgery," Journal of Health Economics, Elsevier, vol. 63(C), pages 81-99.
    14. repec:zbw:rwirep:0527 is not listed on IDEAS
    15. Corinna Hentschker & Roman Mennicken, 2014. "Selective-referral and Unobserved Patient Heterogeneity – Bias in the Volume-outcome Relationship," Ruhr Economic Papers 0527, Rheinisch-Westfälisches Institut für Wirtschaftsforschung, Ruhr-Universität Bochum, Universität Dortmund, Universität Duisburg-Essen.
    16. Rachet-Jacquet, Laurie & Gutacker, Nils & Siciliani, Luigi, 2021. "Scale economies in the health sector: The effect of hospital volume on health gains from hip replacement surgery," Journal of Economic Behavior & Organization, Elsevier, vol. 190(C), pages 704-729.
    17. Justin G. Trogdon, 2004. "Regionalization of Cardiac Services and the Responsiveness of Treatment Choices," HEW 0411001, University Library of Munich, Germany.
    18. Carine Milcent, 2005. "Hospital ownership, reimbursement systems and mortality rates," Health Economics, John Wiley & Sons, Ltd., vol. 14(11), pages 1151-1168, November.
    19. Avdic, Daniel & Lundborg, Petter & Vikström, Johan, 2014. "Learning-by-Doing in a High-Skill Profession when Stakes are High: Evidence from Advanced Cancer Surgery," VfS Annual Conference 2014 (Hamburg): Evidence-based Economic Policy 100278, Verein für Socialpolitik / German Economic Association.
    20. Corinna Hentschker & Roman Mennicken, 2015. "The Volume‐Outcome Relationship and Minimum Volume Standards – Empirical Evidence for Germany," Health Economics, John Wiley & Sons, Ltd., vol. 24(6), pages 644-658, June.
    21. Corinna Hentschker & Roman Mennicken, 2012. "The Relationship between Quality and Hospital Case Volume – An Empirical Examination with German Data," Ruhr Economic Papers 0341, Rheinisch-Westfälisches Institut für Wirtschaftsforschung, Ruhr-Universität Bochum, Universität Dortmund, Universität Duisburg-Essen.
    22. Jakub Červený, 2023. "Selective referral or learning by doing? An analysis of hospital volume‐outcome relationship of vascular procedures," Health Economics, John Wiley & Sons, Ltd., vol. 32(6), pages 1344-1361, June.
    23. repec:zbw:rwirep:0341 is not listed on IDEAS
    24. David Barker & Gary Rosenthal & Peter Cram, 2011. "Simultaneous relationships between procedure volume and mortality: do they bias studies of mortality at specialty hospitals?," Health Economics, John Wiley & Sons, Ltd., vol. 20(5), pages 505-518, May.

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