When and How to Use Instrumental Variables in Palliative Care Research

Penrod, Joan D.; Goldstein, Nathan E.; Deb, Partha

doi:10.1089/jpm.2009.9631

Cited by 20 publications

(12 citation statements)

References 25 publications

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“…It was not possible to identify an instrumental variable for this sample. 34 As a sensitivity analysis, we ran GLM and ordinary least squares regressions on the unweighted sample, and results were substantively similar (Data Supplement). Abbreviations: PC, palliative care; UC, usual care.…”

Section: Discussionmentioning

confidence: 80%

Prospective Cohort Study of Hospital Palliative Care Teams for Inpatients With Advanced Cancer: Earlier Consultation Is Associated With Larger Cost-Saving Effect

May

Garrido

Cassel

et al. 2015

JCO

221

207

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A B S T R A C T PurposePrevious studies report that early palliative care is associated with clinical benefits, but there is limited evidence on economic impact. This article addresses the research question: Does timing of palliative care have an impact on its effect on cost? Patients and MethodsUsing a prospective, observational design, clinical and cost data were collected for adult patients with an advanced cancer diagnosis admitted to five US hospitals from 2007 to 2011. The sample for economic evaluation was 969 patients; 256 were seen by a palliative care consultation team, and 713 received usual care only. Subsamples were created according to time to consult after admission. Propensity score weights were calculated, matching the treatment and comparison arms specific to each subsample on observed confounders. Generalized linear models with a ␥ distribution and a log link were applied to estimate the mean treatment effect on cost within subsamples. ResultsEarlier consultation is associated with a larger effect on total direct cost. Intervention within 6 days is estimated to reduce costs by Ϫ$1,312 (95% CI, Ϫ$2,568 to Ϫ$56; P ϭ .04) compared with no intervention and intervention within 2 days by Ϫ$2,280 (95% CI, Ϫ$3,438 to Ϫ$1,122; P Ͻ .001); these reductions are equivalent to a 14% and a 24% reduction, respectively, in cost of hospital stay. ConclusionEarlier palliative care consultation during hospital admission is associated with lower cost of hospital stay for patients admitted with an advanced cancer diagnosis. These findings are consistent with a growing body of research on quality and survival suggesting that early palliative care should be more widely implemented.

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Section: Discussionmentioning

confidence: 80%

Prospective Cohort Study of Hospital Palliative Care Teams for Inpatients With Advanced Cancer: Earlier Consultation Is Associated With Larger Cost-Saving Effect

May

Garrido

Cassel

et al. 2015

JCO

221

207

View full text Add to dashboard Cite

show abstract

“…Second, we attempted to more explicitly control for potential unobserved confounders by estimating alternative GLM regressions in which indicator variables for the attending physician were used as instruments (Penrod, Goldstein, and Deb 2009;Penrod et al 2010). Due to the nonlinear nature of the regression model, we estimated the instrumental variables GLM using two-stage residual inclusion (Terza, Basu, and Rathouz 2008).…”

Section: Discussionmentioning

confidence: 99%

Cost Savings from Palliative Care Teams and Guidance for a Financially Viable Palliative Care Program

McCarthy

Robinson

Huq

et al. 2014

Health Services Research

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“…IV approaches are common in economics, but are also increasingly used in health systems research (see, for instance [55][56][57]). Overall, quasi-experimental observational research designs (such as IV, RD, CBA, or ITS,) can potentially generate unbiased effect size estimates, even in those cases where, after controlling for observed covariates, the probability that a unit of observation receives a reform or an intervention depends on the outcome of interest.…”

Section: Discussionmentioning

confidence: 99%

Study-design selection criteria in systematic reviews of effectiveness of health systems interventions and reforms: A meta-review

et al. 2012

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When and How to Use Instrumental Variables in Palliative Care Research

Cited by 20 publications

References 25 publications

Prospective Cohort Study of Hospital Palliative Care Teams for Inpatients With Advanced Cancer: Earlier Consultation Is Associated With Larger Cost-Saving Effect

Prospective Cohort Study of Hospital Palliative Care Teams for Inpatients With Advanced Cancer: Earlier Consultation Is Associated With Larger Cost-Saving Effect

Cost Savings from Palliative Care Teams and Guidance for a Financially Viable Palliative Care Program

Study-design selection criteria in systematic reviews of effectiveness of health systems interventions and reforms: A meta-review

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