title: Demand, selection and patient outcomes in German acute care hospitals.
abstract: This paper examines the effects of variation in unexpected demand on patient outcomes in acute care German hospitals. Naturally, an unexpected surge in demand may negatively affect the quality of care and thus patient outcomes, such as in-hospital mortality. We estimate models explaining patient outcomes depending on demand, unobservable patient selection and seasonal factors, as well as patient-specific risk factors and unobservable hospital and department fixed-effects. The main message of this analysis is that hospitals are well prepared to deal with this unexpected volatility in demand, as by and large it does not negatively affect patient outcomes. Hospitals seem to deal with high unexpected workload by steering the patients' length of stay relating to their severity of illness. Elective patients are discharged earlier, while discharges of high-risk emergency patients are postponed.
authors.affiliation: KCE - Belgian Health Care Knowledge Centre, Boulevard du Jardin Botanique, Brussels, Belgium. Christoph.Schwierz@kce.fgov.be
authors.forename: Christoph
authors.initials: C
authors.lastname: Schwierz
authors.forename: Boris
authors.initials: B
authors.lastname: Augurzky
authors.forename: Axel
authors.initials: A
authors.lastname: Focke
authors.forename: Jürgen
authors.initials: J
authors.lastname: Wasem
mesh_terms: D003953:Diagnosis-Related Groups; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D005858:Germany / Q000453:epidemiology; D017052:Hospital Mortality; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D008297:Male; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D012044:Regression Analysis; D012307:Risk Factors