Does Practice Make Perfect

Part II: The Relation Between Volume and and Outcomes and Other Hospital Characteristics

Bibliographic Data

ID9104546
AuthorsAnn Barry Flood (0000-0002-4035-3084, University of Illinois Urbana-Champaign, corresponding author), W Richard Scott (Stanford University), Wayne Ewy
Year1984
Volume22
Issue2
Pages115-125
Publication date1984-02-01
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueMedical Care (JOURNAL)
Journal identifiersISSN: 0025-7079 • E-ISSN: 1537-1948
PublisherOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/00005650-198402000-00003
PMID6422168
OpenAlexW1965351821
LanguageEN
Citations received28

The effect of a greater volume of patients with similar conditions being treated at a hospital on the outcomes achieved is investigated for almost 500,000 selected surgical and medical patients treated in over 1,200 nonfederal United States hospitals. In Part I the authors found strong and consistent evidence for surgical patients that high volume is associated with better outcome; evidence for medical patients was mixed. In this paper the authors include other hospital variables related both to volume and outcome--hospital size, teaching status, and expenditures--to determine whether they mask the true relationship; still, strong and consistent evidence that greater volume produces better outcome was found for both surgical and medical patients. This relation was significant for low-, medium-, and high-risk patients. Among the hospital variations added, only size was consistently and strongly related to outcome; greater size was associated with poorer outcome after accounting for volume. The potential importance of the findings for reducing deaths and days in hospital on a national level is discussed. The evidence is strongly supportive of the need for policies that would promote greater regionalization of a given service, and not greater size, to obtain better quality outcome for patients treated

Intensive care medicine · Outcome (game theory) · Emergency Medicine · Healthcare Policy and Management · Medicine · Patient Satisfaction in Healthcare · Primary Care and Health Outcomes