Treatment effect bounds: an application to Swan-Ganz catherization
We implement alternative bounding strategies to reanalyze data from the observational study by Connors et al. (1996) on the impact of Swan-Ganz catheterization on mortality outcomes. We implement both traditional bounds, which exploit access to an instrumental variable but impose no other assumption...
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| Hauptverfasser: | , , |
|---|---|
| Format: | Buch |
| Sprache: | English |
| Veröffentlicht: |
Cambridge, Mass.
National Bureau of Economic Research
2005
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| Schriftenreihe: | National Bureau of Economic Research <Cambridge, Mass.>: NBER working paper series
11263 |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Zusammenfassung: | We implement alternative bounding strategies to reanalyze data from the observational study by Connors et al. (1996) on the impact of Swan-Ganz catheterization on mortality outcomes. We implement both traditional bounds, which exploit access to an instrumental variable but impose no other assumptions (Manski, 1990), and the new bounds of Shaikh and Vytlacil (2004), which impose additional relatively mild nonparametric structural assumptions. Both of these approaches require an instrumental variable that shifts the probability of catheterization, but that does not alter mortality risks. We propose and justify using indicators of weekday admission as an instrumental variable in this context.<br>We find that, while the traditional instrumental variable bounds are almost entirely uninformative in our application, the Shaikh and Vytlacil (2004) bounds often produce a clear answer - catheterization reduces mortality at 7 days, and increases it at 30 days and after. Our findings suggest an explanation for the fact that many ICU doctors are deeply committed to the use of the Swan-Ganz catheter. Since most ICU patients leave the ICU well before 30 days after admission have elapsed, ICU doctors never observe the increase in mortality. They do, however, observe the decline in mortality at 7 days. |
| Beschreibung: | 44 S. graph. Darst. |
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| 520 | 3 | |a We implement alternative bounding strategies to reanalyze data from the observational study by Connors et al. (1996) on the impact of Swan-Ganz catheterization on mortality outcomes. We implement both traditional bounds, which exploit access to an instrumental variable but impose no other assumptions (Manski, 1990), and the new bounds of Shaikh and Vytlacil (2004), which impose additional relatively mild nonparametric structural assumptions. Both of these approaches require an instrumental variable that shifts the probability of catheterization, but that does not alter mortality risks. We propose and justify using indicators of weekday admission as an instrumental variable in this context.<br>We find that, while the traditional instrumental variable bounds are almost entirely uninformative in our application, the Shaikh and Vytlacil (2004) bounds often produce a clear answer - catheterization reduces mortality at 7 days, and increases it at 30 days and after. Our findings suggest an explanation for the fact that many ICU doctors are deeply committed to the use of the Swan-Ganz catheter. Since most ICU patients leave the ICU well before 30 days after admission have elapsed, ICU doctors never observe the increase in mortality. They do, however, observe the decline in mortality at 7 days. | |
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| index_date | 2024-07-02T22:41:28Z |
| indexdate | 2024-07-09T21:25:11Z |
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| spelling | Bhattacharya, Jay Verfasser (DE-588)124158250 aut Treatment effect bounds an application to Swan-Ganz catherization Jay Bhattacharya ; Azeem M. Shaikh ; Edward Vytlacil Cambridge, Mass. National Bureau of Economic Research 2005 44 S. graph. Darst. txt rdacontent n rdamedia nc rdacarrier National Bureau of Economic Research <Cambridge, Mass.>: NBER working paper series 11263 We implement alternative bounding strategies to reanalyze data from the observational study by Connors et al. (1996) on the impact of Swan-Ganz catheterization on mortality outcomes. We implement both traditional bounds, which exploit access to an instrumental variable but impose no other assumptions (Manski, 1990), and the new bounds of Shaikh and Vytlacil (2004), which impose additional relatively mild nonparametric structural assumptions. Both of these approaches require an instrumental variable that shifts the probability of catheterization, but that does not alter mortality risks. We propose and justify using indicators of weekday admission as an instrumental variable in this context.<br>We find that, while the traditional instrumental variable bounds are almost entirely uninformative in our application, the Shaikh and Vytlacil (2004) bounds often produce a clear answer - catheterization reduces mortality at 7 days, and increases it at 30 days and after. Our findings suggest an explanation for the fact that many ICU doctors are deeply committed to the use of the Swan-Ganz catheter. Since most ICU patients leave the ICU well before 30 days after admission have elapsed, ICU doctors never observe the increase in mortality. They do, however, observe the decline in mortality at 7 days. Cardiac catheterization Hospital patients - Mortality Krankenhaus / Sterblichkeit Shaikh, Azeem M. Verfasser (DE-588)130506613 aut Vytlacil, Edward 1972- Verfasser (DE-588)130529834 aut Erscheint auch als Online-Ausgabe National Bureau of Economic Research <Cambridge, Mass.>: NBER working paper series 11263 (DE-604)BV002801238 11263 http://papers.nber.org/papers/w11263.pdf kostenfrei Volltext |
| spellingShingle | Bhattacharya, Jay Shaikh, Azeem M. Vytlacil, Edward 1972- Treatment effect bounds an application to Swan-Ganz catherization National Bureau of Economic Research <Cambridge, Mass.>: NBER working paper series Cardiac catheterization Hospital patients - Mortality Krankenhaus / Sterblichkeit |
| title | Treatment effect bounds an application to Swan-Ganz catherization |
| title_auth | Treatment effect bounds an application to Swan-Ganz catherization |
| title_exact_search | Treatment effect bounds an application to Swan-Ganz catherization |
| title_exact_search_txtP | Treatment effect bounds an application to Swan-Ganz catherization |
| title_full | Treatment effect bounds an application to Swan-Ganz catherization Jay Bhattacharya ; Azeem M. Shaikh ; Edward Vytlacil |
| title_fullStr | Treatment effect bounds an application to Swan-Ganz catherization Jay Bhattacharya ; Azeem M. Shaikh ; Edward Vytlacil |
| title_full_unstemmed | Treatment effect bounds an application to Swan-Ganz catherization Jay Bhattacharya ; Azeem M. Shaikh ; Edward Vytlacil |
| title_short | Treatment effect bounds |
| title_sort | treatment effect bounds an application to swan ganz catherization |
| title_sub | an application to Swan-Ganz catherization |
| topic | Cardiac catheterization Hospital patients - Mortality Krankenhaus / Sterblichkeit |
| topic_facet | Cardiac catheterization Hospital patients - Mortality Krankenhaus / Sterblichkeit |
| url | http://papers.nber.org/papers/w11263.pdf |
| volume_link | (DE-604)BV002801238 |
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