Add events listings to our new community calendar

For several years, we’ve provided health economics events listings at aheblog.com/events. Today we’re pleased to announce a new and vastly improved community events calendar.

The events calendar is available in its usual place. However, you can now submit full details for relevant events that can be reviewed by the editorial team before publication on our website. What’s more, you can make edits to these events after they have been published. All you need is a WordPress.com account.

We will be accepting listing submissions for conferences, workshops, seminars, and other events of interest to health economists, each of which can be shown in separate calendars. And we’ll now be accepting listings for training courses.

This feature was made possible through the support of our patrons. If you’d like to support the blog, and see more improvements to the website, you can become a patron on Patreon.

If you have any queries about the new events listings, please contact us.

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Support the blog – become a patron

We’re well into our 7th year here at blog HQ, and we’re pleased with what we’ve achieved. Back in February 2011, there wasn’t much online discussion of health economics beyond the traditional journals. Now, we have a multi-national roster of academic authors contributing high-quality output every week. Some of our blog posts have been cited in the published literature and at conferences. We like to think we’ve had a positive impact on our discipline.

All of our authors work on a voluntary basis. There’s also a lot of work that goes on behind the scenes, in terms of coordinating and editing contributions and maintaining the website. There is also some small expense associated with running the site. But we think it’s all worthwhile, and we hope to continue to provide free-to-read academic-standard blog posts long into the future.

But we’d like to do even more. We’d like to introduce new regular features to make the blog even more useful to our readers. We’d like to bring additional functionality to the website and improve our accessibility and design, while maintaining the high quality of our output.

To this end, we’re looking for your support. You can now become a patron for the blog. By making a small regular payment you can enable us to improve our website, and send a strong signal to us that we should continue doing what we do. We’ll be very clear about where your money is going and hope to offer special perks to our patrons. As a patron, you’ll also have a say in determining our priorities and the future of the blog.

This is new ground for us, and we’re not really sure what is possible. We’d really welcome your feedback on this initiative. What would you like to see more of from the blog? How could we improve our output? What kind of benefits would you like to receive as a patron?

Head over to Patreon to become a patron from as little as $1 per month. As ever, if you have any questions, send us a message.

Hawking is right, Jeremy Hunt does egregiously cherry pick the evidence

I’m beginning to think Jeremy Hunt doesn’t actually care what the evidence says on the weekend effect. Last week, renowned physicist Stephen Hawking criticized Hunt for ‘cherry picking’ evidence with regard to the ‘weekend effect’: that patients admitted at the weekend are observed to be more likely than their counterparts admitted on a weekday to die. Hunt responded by doubling down on his claims:

Some people have questioned Hawking’s credentials to speak on the topic beyond being a user of the NHS. But it has taken a respected public figure to speak out to elicit a response from the Secretary of State for Health, and that should be welcomed. It remains the case though that a multitude of experts do continue to be ignored. Even the oft-quoted Freemantle paper is partially ignored where it notes of the ‘excess’ weekend deaths, “to assume that [these deaths] are avoidable would be rash and misleading.”

We produced a simple tool to demonstrate how weekend effect studies might estimate an increased risk of mortality associated with weekend admissions even in the case of no difference in care quality. However, the causal model underlying these arguments is not always obvious. So here it is:

weekend

A simple model of the effect of the weekend on patient health outcomes. The dashed line represents unobserved effects

 

So what do we know about the weekend effect?

  1. The weekend effect exists. A multitude of studies have observed that patients admitted at the weekend are more likely to die than those admitted on a weekday. This amounts to having shown that E(Y|W,S) \neq E(Y|W',S). As our causal model demonstrates, being admitted is correlated with health and, importantly, the day of the week. So, this is not the same as saying that risk of adverse clinical outcomes differs by day of the week if you take into account propensity for admission, we can’t say E(Y|W) \neq E(Y|W'). Nor does this evidence imply care quality differs at the weekend, E(Q|W) \neq E(Q|W'). In fact, the evidence only implies differences in care quality if the propensity to be admitted is independent of (unobserved) health status, i.e. Pr(S|U,X) = Pr(S|X) (or if health outcomes are uncorrelated with health status, which is definitely not the case!).
  2. Admissions are different at the weekend. Fewer patients are admitted at the weekend and those that are admitted are on average more severely unwell. Evidence suggests that the better patient severity is controlled for, the smaller the estimated weekend effect. Weekend effect estimates also diminish in models that account for the selection mechanism.
  3. There is some evidence that care quality may be worse at the weekend (at least in the United States). So E(Q|W) \neq E(Q|W'). Although this has not been established in the UK (we’re currently investigating it!)
  4. Staffing levels, particularly specialist to patient ratios, are different at the weekend, E(X|W) \neq E(X|W').
  5. There is little evidence to suggest how staffing levels and care quality are related. While the relationship seems evident prima facie, its extent is not well understood, for example, we might expect a diminishing return to increased staffing levels.
  6. There is a reasonable amount of evidence on the impact of care quality (preventable errors and adverse events) on patient health outcomes.

But what are we actually interested in from a policy perspective? Do we actually care that it is the weekend per se? I would say no, we care that there is potentially a lapse in care quality. So, it’s a two part question: (i) how does care quality (and hence avoidable patient harm) differ at the weekend E(Q|W) - E(Q|W') = ?; and (ii) what effect does this have on patient outcomes E(Y|Q)=?. The first question answers to what extent policy may affect change and the second gives us a way of valuing that change and yet the vast majority of studies in the area address neither. Despite there being a number of publicly funded research projects looking at these questions right now, it’s the studies that are not useful for policy that keep being quoted by those with the power to make change.

Hawking is right, Jeremy Hunt has egregiously cherry picked and misrepresented the evidence, as has been pointed out again and again and again and again and … One begins to wonder if there isn’t some motive other than ensuring long run efficiency and equity in the health service.

Credits