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The influence of hospital or physician volume on quality of health care

Author: Inger Natvig Norderhaug; Nasjonalt kunnskapssenter for helsetjenesten,
Publisher: Oslo, Norway : Norwegian Knowledge Centre for the Health Services, 2007.
Series: Online access: NCBI NCBI Bookshelf.
Edition/Format:   eBook : Document : EnglishView all editions and formats
Summary:
BACKGROUND Assessing and measuring quality of care has had increasing attention during the last decades. The question whether provider volume (hospital or physician) is associated with improved quality of care had been one dimension that has received much attention. The implication of this reserach is important for desicions regarding accreditation of hospitals or surgeons, centralisation or decentralisation of  Read more...
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Details

Genre/Form: Systematic Review
Material Type: Document, Internet resource
Document Type: Internet Resource, Computer File
All Authors / Contributors: Inger Natvig Norderhaug; Nasjonalt kunnskapssenter for helsetjenesten,
OCLC Number: 1048159072
Notes: Excerpt from the full technical report, which is written in Norwegian: Pasientvolum og behandlingskvalitet ved hjerte- og karsykdommer. The excerpt provides the report’s main messages in English. Health technology assessment publication, No. 10-2007.
Description: 1 online resource (1 PDF file (pages 7-11))
Series Title: Online access: NCBI NCBI Bookshelf.
Responsibility: authors, Inger Norderhaug, Unni Krogstad, Tor Ingebrigtsen, Odd Søreide, Rune Wiseth, Hans Olav Myhre.

Abstract:

BACKGROUND Assessing and measuring quality of care has had increasing attention during the last decades. The question whether provider volume (hospital or physician) is associated with improved quality of care had been one dimension that has received much attention. The implication of this reserach is important for desicions regarding accreditation of hospitals or surgeons, centralisation or decentralisation of health care. METHODS A systematic review of studies identified from searches in Medline until 2006. We restricted our inclusion criteria to studies with data from 1990 and forward. The review was performed according to general priciples for HTA. RESULTS PCI: We included 37 publications. Although the results were not completely consistent, the majority of studies reported that patients treated in high volume hospitals had lower risk of mortality or emergent coronary bypass procedure compared with patients treated in low volume hospitals. This was found both for acute and elective PCI. Carotid endarterectomy: We included 17 publications, that due to double publication represented 15 analyses. The results from these studies were not consistent, neither for risk of mortality nor for risk of stroke following carotid endarterectomy. Abdominal aortic surgery: We included 20 publications that evaluated the volume outcome relationship for intact or ruptured abdominal aortic aneurysms. Several publications had overlapping data material. Results from studies in Finland, Canada and the US showed lower mortality rates for patients treated by high volume surgeons. The impact of hospital volume on outcomes following surgery for abdominal aortic aneurysms were not consistent. Intracranial aneurysm and stroke: We included four publications that assessed hospital volume and mortality for intracranial aneurysms. The results from these studies are not consistent, and insufficient for conclusions. We included five publications on hospital volume and outcomes in the treatment of stroke patients. The results from these studies were not consistent, neither for treatment of stroke patients in general nor for the group of patients treated with thrombolysis. CABG: We included 17 publications on coronary artery bypass graft surgery (CABG), which due to multiple publications from the same database constitute 11 analyses. Altogether these studies showed lower rates of mortality and complications for patients treated in high volume hospitals and by high volume surgeons. Heart valve surgery: We included four studies on heart valve surgery. All were from the US and three analysed the same database for overlapping period. All studies reported lower rates of mortality for high volume hospitals and high volume surgeons. But due to few unique publications more data is needed to confirm this finding. CONCLUSION High hospital or physician volume is associated with better outcome for some procedures. The majority of studies were from the US, and studies from other countries are needed to assess the consistency of findings across health care systems.

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