Evaluating disease management programme effectiveness: an introduction to instrumental variables

被引：29

作者：

Linden, A

Adams, JL

机构：

[1] Linden Consulting Grp, Hillsboro, OR 97124 USA

[2] Oregon Hlth & Sci Univ, Sch Med, Dept Prevent Hlth Prevent Med, Portland, OR USA

[3] RAND Corp, Santa Monica, CA USA

来源：

JOURNAL OF EVALUATION IN CLINICAL PRACTICE | 2006年 / 12卷 / 02期

关键词：

disease management; instrumental variables; observational studies; unobserved covariates;

D O I：

10.1111/j.1365-2753.2006.00615.x

中图分类号：

R19 [保健组织与事业（卫生事业管理）];

学科分类号：

摘要：

This paper introduces the concept of instrumental variables (IVs) as a means of providing an unbiased estimate of treatment effects in evaluating disease management (DM) programme effectiveness. Model development is described using zip codes as the IV. Three diabetes DM outcomes were evaluated: annual diabetes costs, emergency department (ED) visits and hospital days. Both ordinary least squares (OLS) and IV estimates showed a significant treatment effect for diabetes costs (P = 0.011) but neither model produced a significant treatment effect for ED visits. However, the IV estimate showed a significant treatment effect for hospital days (P = 0.006) whereas the OLS model did not. These results illustrate the utility of IV estimation when the OLS model is sensitive to the confounding effect of hidden bias.

引用

页码：148 / 154

页数：7

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