The current conventional wisdom holds that higher volume hospitals produce better outcomes in a number of surgical procedures and have lower rates of patient mortality. But a new study published in Applied Health Economics and Health Policy calls that idea into question.
The link between high numbers of procedures and favorable outcomes has been overstated, according to Rice University researchers. Analysis of data from the American Hospital Association Annual Survey of Hospitals from 2000 to 2011 found that high volume alone does not account for some hospitals' and healthcare systems' success. In fact, researchers say, numerous factors contribute to positive patient outcomes.
The team studied outcomes for six complex cancer operations that showed a correlation between high volume and positive outcomes. Previous studies, the team said, relied on the simplest statistical models to determine the volume-outcome relationship. Applying more sophisticated statistical models, they found that only four of the procedures in fact benefited from higher volume settings.
"If patients are in need one of these operations, they most likely will rely on advice from their physician on which hospital to get treated at," said Vivian Ho, study co-author and chair in health economics at Rice's Baker Institute for Public Policy and director of the institute's Center for Health and Biosciences, in an announcement. "But physicians who consult the medical literature for guidance on where to send their patients may be getting incomplete information. The medical literature may be overemphasizing the role that hospital volume plays in patient outcomes."
Last year, a group of major providers went so far as to place limits on what procedures could be performed at low-volume hospitals and by low-volume "cowboy" surgeons who take on procedures that they don't usually perform.