Using Length of Stay to Control for Unobserved Heterogeneity When Estimating Treatment Effect on Hospital Costs with Observational Data: Issues of Reliability, Robustness, and Usefulness

Health Services Research
Peter MayCharles Normand

Abstract

To evaluate the sensitivity of treatment effect estimates when length of stay (LOS) is used to control for unobserved heterogeneity when estimating treatment effect on cost of hospital admission with observational data. We used data from a prospective cohort study on the impact of palliative care consultation teams (PCCTs) on direct cost of hospital care. Adult patients with an advanced cancer diagnosis admitted to five large medical and cancer centers in the United States between 2007 and 2011 were eligible for this study. Costs were modeled using generalized linear models with a gamma distribution and a log link. We compared variability in estimates of PCCT impact on hospitalization costs when LOS was used as a covariate, as a sample parameter, and as an outcome denominator. We used propensity scores to account for patient characteristics associated with both PCCT use and total direct hospitalization costs. We analyzed data from hospital cost databases, medical records, and questionnaires. Our propensity score weighted sample included 969 patients who were discharged alive. In analyses of hospitalization costs, treatment effect estimates are highly sensitive to methods that control for LOS, complicating interpretation. Both t...Continue Reading

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Citations

Jul 12, 2019·Journal of Health Services Research & Policy·Eoin TiernanPeter May
Nov 10, 2018·BMJ Supportive & Palliative Care·Hassan AssarehHelen M Achat
Sep 17, 2020·Annals of the American Thoracic Society·Katherine R CourtrightUNKNOWN PONDER-ICU Investigative Team
Jan 20, 2019·Medical Care Research and Review : MCRR·Peter MayJ Brian Cassel
Aug 27, 2017·Journal of Pain and Symptom Management·Peter MayJ Brian Cassel
Mar 4, 2021·Journal of Palliative Medicine·Luciana Martins RozmanPatrícia Coelho de Soárez
Mar 13, 2018·Journal of Pain and Symptom Management·Sanders ChangKavita V Dharmarajan
Sep 23, 2020·BMJ Supportive & Palliative Care·Elene JanberidzeMartin Loučka

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