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Measuring the Volume-Outcome Relation for Complex Hospital Surgery

Author

Listed:
  • Woohyeon Kim

    (Rice University)

  • Stephen Wolff

    (Rice University)

  • Vivian Ho

    (Rice University
    Rice University
    Baylor College of Medicine)

Abstract

Background Prominent studies continue to measure the hospital volume-outcome relation using simple logistic or random-effects models. These regression models may not appropriately account for unobserved differences across hospitals (such as differences in organizational effectiveness) which could be mistaken for a volume outcome relation. Objective To explore alternative estimation methods for measuring the volume-outcome relation for six major cancer operations, and to determine which estimation method is most appropriate. Methods We analyzed patient-level hospital discharge data from three USA states and data from the American Hospital Association Annual Survey of Hospitals from 2000 to 2011. We studied six major cancer operations using three regression frameworks (logistic, fixed-effects, and random-effects) to determine the correlation between patient outcome (mortality) and hospital volume. Results For our data, logistic and random-effects models suggest a non-zero volume effect, whereas fixed-effects models do not. Model-specification tests support the fixed-effects or random-effects model, depending on the surgical procedure; the basic logistic model is always rejected. Esophagectomy and rectal resection do not exhibit significant volume effects, whereas colectomy, pancreatic resection, pneumonectomy, and pulmonary lobectomy do. Conclusions The statistical significance of the hospital volume-outcome relation depends critically on the regression model. A simple logistic model cannot control for unobserved differences across hospitals that may be mistaken for a volume effect. Even when one applies panel-data methods, one must carefully choose between fixed- and random-effects models.

Suggested Citation

  • 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.
  • Handle: RePEc:spr:aphecp:v:14:y:2016:i:4:d:10.1007_s40258-016-0241-6
    DOI: 10.1007/s40258-016-0241-6
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    References listed on IDEAS

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    1. Ho, Vivian & Town, Robert J. & Heslin, Martin J., 2007. "Regionalization versus competition in complex cancer surgery," Health Economics, Policy and Law, Cambridge University Press, vol. 2(1), pages 51-71, January.
    2. Po-Li Wei & Shih-Ping Liu & Joseph J Keller & Herng-Ching Lin, 2012. "Volume-Outcome Relation for Acute Appendicitis: Evidence from a Nationwide Population-Based Study," PLOS ONE, Public Library of Science, vol. 7(12), pages 1-5, December.
    3. Xie, Jipan & Dow, William H., 2005. "Longitudinal study of child immunization determinants in China," Social Science & Medicine, Elsevier, vol. 61(3), pages 601-611, August.
    4. Ho Vivian & Short Marah N. & Ku-Goto Meei-Hsiang, 2012. "Can Centralization of Cancer Surgery Improve Social Welfare?," Forum for Health Economics & Policy, De Gruyter, vol. 15(1), pages 1-25, October.
    5. 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.
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