Who gets the credit Determinants of the probability of谁得到信贷的概率的决定因素.pptVIP

“Peak demand in hospitals and patient outcomes”  Christoph Schwierz, RWI Essen Boris Augurzky, RWI Essen, IZA BonnAxel Focke, University Duisburg-EssenJürgen Wasem, University Duisburg-Essen Introduction Research question Sudden surge in demand Quality of treatment of hospital-in-patients? Rationale High variation in daily patient volume Legal requirements for staff-to-patient ratios? Literature review Comparing patient outcomes across hospitals Unobservable hospital differences Unobservable selection of patients Comparing patient outcomes within hospitals Unobservable selection of patients Issues Data and samples Key variables: Patient outcomes, demand, selection Estimation strategies Data Hospital discharge data 730.000 patient cases From 430 medical departments within 72 acute- care German hospitals Patient characteristics: Age, sex, insurance type Several risk-adjusters: 4-digit diagnosis, patient clinical complexity level, relative diagnosis weight, etc. Samples Patient outcomes Excess length of stay In-hospital mortality Died within 1 day after admission Died within hospital stay Emergency readmission Readmitted as an emergency case within 15 days after last discharge Key variables:Unexpected Demand Variation Deviation of actual from predicted patient count Result 89% of variation in patient volume is predictable Key variables: Unobservable selection Excess share of admissions (Dobkin 2003) Excess weekend mortality due to higher unobservable frailty of patients admitted on weekends With selection index excess mortality on weekends disappears Descriptive StatisticsPatient characteristics and outcomes by sample Estimation strategy Multivariate econometric methods Length of stay increases with unexpected demand for emergency and decreases for elective admissions Length of stay increases with excess admission ratio After selection correction no significant impact of demand on 1 day mortalityHigh-risk emergency sample Summary o