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The weekend effect revisited: evidence from the Upper Austrian stroke registry

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Abstract

Empirical evidence on the so-called ‘weekend-effect’ on stroke mortality is mixed with some studies reporting significantly higher mortality for weekend admissions and others finding no difference. The aim of this paper is to enhance the evidence on the weekend-effect on stroke mortality using a rich stroke registry data set from Upper Austria and to discuss underlying reasons for the heterogeneity in results. Using logistic regressions and ordinary least squares regressions with hospital and year-fixed effects, the outcomes of weekend versus weekday admissions are compared for patients admitted to 16 hospitals in Upper Austria with transient ischemic attack (TIA), cerebral infarction or hemorrhage between 2007 and 2015. The primary outcomes include in-hospital mortality, 30-day and 90-day all-cause mortality as well as the length of hospital stay. In addition, we analyze differences in process-quality indicators between weekdays and weekends. Our results show that on weekends there are on average 25% fewer admissions than on weekdays with significantly higher in-hospital mortality. Adjusting for case-mix, the association between weekend admissions and mortality becomes null suggesting that the higher mortality on weekends is explained by heterogeneities in admissions rather than health-care quality.

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Notes

  1. The LKF system is a patient classification system similar to the diagnosis-related groups (DRG) system with the hospital reimbursement being primarily based on the patients’ diagnosis [57].

  2. When using the Barthel index or the Rankin scale instead of the NIHSS as severity measures, the adjusted weekend-effect diminishes in size but still remains significant in some instances indicating that the two alternative severity measures do not capture the same latent variable as the NIHSS. Also the pseudo R-squared is lower when using the Barthel or Rankin instead of the NIHSS indicating lower predictive power of the alternative severity measures which is in line with the findings of Rost et al. [55]. Analysis not shown but available upon request.

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Acknowledgements

The authors would like to thank the Upper Austrian Regional Health Insurance (OÖ GKK), especially Mr. Eckschlager and Mr. Schableger for providing the data and the helpful discussions.

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Authors and Affiliations

  1. UMIT, University for Health Sciences, Medical Informatics and Technology, Institute for Management and Economics in Healthcare, Eduard-Wallnöfer-Zentrum 1, 6060 Hall in Tirol, Austria

    Silvia Angerer, Klaus Buttinger & Harald Stummer

  2. Salzkammergut Klinikum, Miller-von-Aichholz-Straße 49, 4810, Gmunden, Austria

    Klaus Buttinger

  3. University Seeburg Castle, Institut für Gesundheitsmanagement und Innovation, Seeburgstraße 8, 5201, Seekirchen am Wallersee, Austria

    Harald Stummer

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Angerer, S., Buttinger, K. & Stummer, H. The weekend effect revisited: evidence from the Upper Austrian stroke registry. Eur J Health Econ 20, 729–737 (2019). https://doi.org/10.1007/s10198-019-01035-4

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