Sending patients to hospitals with the largest volume of specialty surgical procedures does not necessarily lead to improved outcomes for the overall population, says a Washington State study that appears in the Journal of the American College of Surgeons.
The researchers reviewed findings of studies that suggested that the higher the volume of specialty surgical procedures performed at a hospital, the better the hospital's outcomes. One of the more visible programs in this area has been the Leapfrog Group's decade-old Evidence-Based Hospital Referral (EBHR) program.
The researchers hypothesized that volume-based referrals in turn would "regionalize" patients to certain hospitals meeting EBHR volume metrics--and in the long run, overall patient outcomes for specific procedures would improve statewide.
However, the Washington State study found that impact on patient outcomes across the state was negligible when a greater proportion of pancreatic and esophageal resections were performed at higher volume hospitals, which met a given EBHR volume metric.
Overall, the rates of adverse events were found to be lower at hospitals meeting an EBHR volume metric. However, across Washington State and at non-EBHR centers, mortality, readmission, and complication rates did not improve in the seven years following the introduction of the EBHR initiative in 2001.
"This statewide analysis suggests Leapfrog's EBHR initiative has not had the intended impact of lowering the rate of adverse outcomes for all surgical patients having higher risk surgical procedures," said Nader Massarweh, MD, MPH, a surgical resident at the University of Washington School of Medicine, Seattle, and the study's lead author, in a statement.
For more details:
- here's the journal abstract
- view the release