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Volume and Quality in Hospital Procedures

By April 5, 2010Commentary

Quality in health care should be understood to ultimately be a matter of better health status for patients and better health outcomes in regard to specific services, procedures or products.  It would seem logical that the more a facility or provider performs a certain service or procedure, the better the quality or outcomes should be.  Researchers have pursued this hypothesis for a number of years and it has become commonplace for patients to be advised to look for high-volume providers to increase the odds of a good outcome.

A new study published in the New England Journal of Medicine extends this line of research.  (NEJM Study) (Abstract Only)  The researchers looked at Medicare fee-for-service beneficiaries who were treated for acute myocardial infarction, heart failure or pneumonia at an acute care hospital.  The primary outcome was death.  In general, as a hospital’s volume increased for each condition, mortality was lessened, but the relationship weakened above a certain volume threshhold.  Teaching hospitals reached lower mortality rates at lesser volume than did non-teaching facilities.  And there was variation among categories; even some small-volume hospitals had excellent outcomes.

Much of the prior research has focused on surgical procedures and this article examines common conditions for hospital admission, finding a similar relationship between volume and at least one important outcome.  In an era where transparency and information are prized, this should be relevant data to make available to patients and physicians in regard to particular hospitals.  It should also put some pressure on facilities that don’t have the volumes to become proficient at treating some conditions to find other ways to ensure that they are achieving good outcomes.

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