Publication type: Working paper – expertise – study
Title: Does my high blood pressure improve your survival? : overall and subgroup learning curves in health
Authors: Van Gestel, Raf
Müller, Tobias
Bosmans, Johan
et. al: No
Extent: 30
Issue Date: 2016
Series: HEDG Working Paper series
Series volume: 16/27
Publisher / Ed. Institution: University of York
Publisher / Ed. Institution: York
ISSN: 1751-1976
Language: English
Subject (DDC): 362: Health and social services
Abstract: Learning curves in health are of interest for a wide range of medical disciplines, for multiple types of healthcare providers and policy makers. In this paper, we distinguish between three types of learning when identifying overall learning curves: static learning, learning from cumulative experience and human capital depreciation. In addition, we approach the question of how treating more patients with specific characteristics improves provider performance. Information on the role of subgroups has the potential to better inform new or low outcome providers on how to improve. Statistically however, capturing all subgroup experiences in one analysis introduces strong collinearities among regressors. To soften collinearity problems, we explore the use of Lasso regression as a variable selection method and Theil-Goldberger mixed estimation to augment the available information. We use data from the Belgian Transcatheter Aorta Valve Implantation (TAVI) registry, containing information on the first 860 TAVI procedures in Belgium. Ultimately, we find evidence for both overall and subgroup learning effects: for 2-year survival, we find that the probability of survival is increased by about 0.16%-points for each additional patient treated. For adverse eventslike renal failure and stroke, we find that an extra day between procedures increases the probability for these events by 0.12%-points and 0.07%-points respectively. These overall effects are then split into subgroup effects where we find evidence for positive learning effects from physicians' experience with defibrillation, treating patients with hypertension and the use of certain types of replacement valves during the TAVI procedure.
License (according to publishing contract): Licence according to publishing contract
Departement: School of Management and Law
Organisational Unit: Center for Energy and Environment (CEE)
Appears in collections:Publikationen School of Management and Law

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