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

Listed author(s):
  • Barton H. Hamilton

    (John M. Olin School of Business, Washington University in St Louis, MO, USA)

  • Vivian H. Hamilton

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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Article provided by John Wiley & Sons, Ltd. in its journal Health Economics.

Volume (Year): 6 (1997)
Issue (Month): 4 ()
Pages: 383-395

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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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