Hamilton B H, Hamilton V H
John M. Olin School of Business, Washington University in St Louis, MO 63130, USA.
Health Econ. 1997 Jul-Aug;6(4):383-95. doi: 10.1002/(sici)1099-1050(199707)6:4<383::aid-hec278>3.0.co;2-l.
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.
本文研究了1991年至1993年期间魁北克接受髋部骨折手术患者的手术量与治疗结果之间的关系。我们使用一个具有多个终点的持续时间模型，该模型考虑了研究者观察到和未观察到的患者特征，初步估计表明，较高的手术量与更高的出院生存条件概率相关。然而，这些结果反映的是医院之间的差异，而非医院内部随时间的差异：当我们同时控制随时间固定不变的医院间差异时，在t + 1期比t期进行更多手术的医院，其治疗结果并无显著变化，这正如“熟能生巧”假说所预测的那样。因此，髋部骨折患者的手术量与治疗结果之间的关系似乎反映了高手术量医院和低手术量医院之间的质量差异。
