再次审视量效关系：熟能生巧。
The Volume-Outcome Relationship Revisited: Practice Indeed Makes Perfect.
机构信息
RWI - Leibniz Institute for Economic Research, Essen, Germany.
FOM University of Applied Sciences, Health & Social Services, Essen, Germany.
出版信息
Health Serv Res. 2018 Feb;53(1):15-34. doi: 10.1111/1475-6773.12696. Epub 2017 Sep 4.
Abstract
OBJECTIVE
To examine the causal effect of a hospital's experience with treating hip fractures (volume) on patient treatment outcomes.
DATA SOURCES
We use a full sample of administrative data from German hospitals for 2007. The data provide detailed information on patients and hospitals. We also reference the hospitals' addresses and the zip codes of patients' place of residence.
STUDY DESIGN
We apply an instrumental variable approach to address endogeneity concerns due to reverse causality and unobserved patient heterogeneity. As instruments for case volume, we use the number of potential patients and number of other hospitals in the region surrounding each hospital.
PRINCIPAL FINDINGS
Our results indicate that after applying an instrumental variables (IV) regression of volume on outcome, volume significantly increases quality.
CONCLUSIONS
We provide evidence for the practice-makes-perfect hypothesis by showing that volume is a driving factor for quality.
摘要
目的
考察医院治疗髋部骨折（量）的经验对患者治疗结果的因果效应。
数据来源
我们使用德国医院 2007 年的全部行政数据。该数据提供了有关患者和医院的详细信息。我们还参考了医院的地址和患者居住地的邮政编码。
研究设计
我们采用工具变量法来解决由于反向因果关系和未观察到的患者异质性而导致的内生性问题。作为病例量的工具变量，我们使用每个医院周围的潜在患者数量和其他医院数量。
主要发现
我们的结果表明，在对量与结果进行工具变量（IV）回归后，量显著提高了质量。
结论
我们通过证明量是质量的驱动因素，为实践出真知的假设提供了证据。
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