Chapter 9. Estimating Surgical Volume – Outcome Relationships Applying Survival Models: Accounting for Frailty and Hospital Fixed Effects

  1. Andrew M. Jones3 and
  2. Owen O'Donnell4
  1. Barton H. Hamilton1 and
  2. Vivian H. Ho2

Published Online: 10 JUL 2002

DOI: 10.1002/0470846313.ch9

Econometric Analysis of Health Data

Econometric Analysis of Health Data

How to Cite

Hamilton, B. H. and Ho, V. H. (2002) Estimating Surgical Volume – Outcome Relationships Applying Survival Models: Accounting for Frailty and Hospital Fixed Effects, in Econometric Analysis of Health Data (eds A. M. Jones and O. O'Donnell), John Wiley & Sons, Ltd, Chichester, UK. doi: 10.1002/0470846313.ch9

Editor Information

  1. 3

    Department of Economics and Related Studies, University of York, UK

  2. 4

    Department of Balkan, Slavic and Oriental Studies, University of Macedonia, Thessaloniki, Greece

Author Information

  1. 1

    John M. Olin School of Business, Washington University in St Louis, Campus Box 1133, One Brookings Drive, St Louis MO 63130, USA

  2. 2

    Health Care Organization and Policy, Department of General Practice, University of Alabama Birmingham, RPHB 330, 1530 3rd Ave. South, Birmingham, AL 35294-0022, USA

Publication History

  1. Published Online: 10 JUL 2002
  2. Published Print: 30 APR 2002

ISBN Information

Print ISBN: 9780470841457

Online ISBN: 9780470846315

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Keywords:

  • surgical volume–outcome relationships;
  • survival models;
  • frailty;
  • hospital fixed effects

Summary

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.