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- Title
Evaluating disease management programme effectiveness: an introduction to instrumental variables.
- Authors
Linden, Ariel; Adams, John L.
- Abstract
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.
- Subjects
DISEASE management; INSTRUMENTAL variables (Statistics); THERAPEUTICS; HOSPITALS; DIABETES; EMERGENCY medical services
- Publication
Journal of Evaluation in Clinical Practice, 2006, Vol 12, Issue 2, p148
- ISSN
1356-1294
- Publication type
Article
- DOI
10.1111/j.1365-2753.2006.00615.x