From observing the relationship between volume and outcome to making policy recommendations: comments on Sheikh.

To one who has contributed to the literature on the relationship between volume and outcome and who is concerned about translating research findings into policy recommendations, Sheikh’s paper on “The Reliability of Provider Volume and Outcome Associations for Healthcare Policy” is of considerable interest. In it, he argues with considerable passion and many references that 1) the existing research does not provide a scientific basis for the hypothesized relationship, and 2) policies based on such a relationship are likely to be harmful. Not surprisingly, because I have already disclosed my own intellectual conflicts of interest on this topic and have been asked to write this counterpoint, I disagree. In the next section, I briefly summarize Sheikh’s critique of the empiric literature. The more fundamental issues have to do with 1) scientific assessment of a body of literature of variable quality, 2) the rationale for reaching a conclusion based on nonexperimental data, and 3) applying research results to inform policy decisions. I address each of these in turn.