UMIT, University for Health Sciences, Medical Informatics and Technology, Institute for Management and Economics in Healthcare, Eduard-Wallnöfer-Zentrum 1, 6060 Hall in Tirol, Austria.
Salzkammergut Klinikum, Miller-von-Aichholz-Straße 49, 4810, Gmunden, Austria.
Eur J Health Econ. 2019 Jul;20(5):729-737. doi: 10.1007/s10198-019-01035-4. Epub 2019 Feb 12.
Empirical evidence on the so-called 'weekend-effect' on stroke mortality is mixed with some studies reporting significantly higher mortality for weekend admissions and others finding no difference. The aim of this paper is to enhance the evidence on the weekend-effect on stroke mortality using a rich stroke registry data set from Upper Austria and to discuss underlying reasons for the heterogeneity in results. Using logistic regressions and ordinary least squares regressions with hospital and year-fixed effects, the outcomes of weekend versus weekday admissions are compared for patients admitted to 16 hospitals in Upper Austria with transient ischemic attack (TIA), cerebral infarction or hemorrhage between 2007 and 2015. The primary outcomes include in-hospital mortality, 30-day and 90-day all-cause mortality as well as the length of hospital stay. In addition, we analyze differences in process-quality indicators between weekdays and weekends. Our results show that on weekends there are on average 25% fewer admissions than on weekdays with significantly higher in-hospital mortality. Adjusting for case-mix, the association between weekend admissions and mortality becomes null suggesting that the higher mortality on weekends is explained by heterogeneities in admissions rather than health-care quality.
关于卒中死亡率所谓“周末效应”的经验证据存在差异，一些研究报告周末入院的死亡率显著更高，而其他研究则未发现差异。本文旨在利用来自奥地利上奥地利州的丰富卒中登记数据集，进一步证实卒中死亡率的周末效应，并探讨结果异质性的潜在原因。使用逻辑回归和带有医院和年份固定效应的普通最小二乘回归，比较了 2007 年至 2015 年期间因短暂性脑缺血发作（TIA）、脑梗死或出血而入住上奥地利州 16 家医院的患者周末与工作日入院的结局。主要结局包括住院期间死亡率、30 天和 90 天全因死亡率以及住院时间。此外，我们分析了工作日和周末之间的过程质量指标差异。结果显示，周末入院人数比工作日平均少 25%，住院期间死亡率显著更高。在调整病例组合后，周末入院与死亡率之间的关联变得无关，表明周末死亡率较高是由入院的异质性而非医疗质量差异引起的。
