Regional availability of high-volume hospitals for major surgery.

Despite evidence of increased risks, a large number of patients still have surgery in low-volume hospitals. To better understand why, we used Medicare data to study the regional availability of high-volume hospitals. More than half of patients undergoing three procedures in low-volume hospitals lived in regions lacking a high-volume hospital. Some regions simply lacked enough cases to support a high-volume hospital. Other regions had enough cases but too many hospitals performing them. Although consolidation of surgical services may be feasible in some settings, volume-based referral strategies are impractical for many U.S. regions.

[1]  R H Brook,et al.  The public release of performance data: what do we expect to gain? A review of the evidence. , 2000, JAMA.

[2]  J. Birkmeyer,et al.  Surgical mortality as an indicator of hospital quality: the problem with small sample size. , 2004, JAMA.

[3]  P. Romano,et al.  Do Well-Publicized Risk-Adjusted Outcomes Reports Affect Hospital Volume? , 2004, Medical care.

[4]  R F Nease,et al.  Patient preferences for location of care: implications for regionalization. , 1999, Medical care.

[5]  Peter J Pronovost,et al.  Physician staffing patterns and clinical outcomes in critically ill patients: a systematic review. , 2002, JAMA.

[6]  Russell S. Kirby,et al.  The Dartmouth Atlas of Health Care , 1998 .

[7]  A M Epstein,et al.  Influence of cardiac-surgery performance reports on referral practices and access to care. A survey of cardiovascular specialists. , 1996, The New England journal of medicine.

[8]  Justin B Dimick,et al.  Potential benefits of the new Leapfrog standards: effect of process and outcomes measures. , 2004, Surgery.

[9]  J. Birkmeyer.  Should we regionalize major surgery? Potential benefits and policy considerations. , 2000, Journal of the American College of Surgeons.

[10]  O. Søreide,et al.  Total mesorectal excision for rectal cancer – what can be achieved by a national audit? , 2003, Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland.

[11]  J. Birkmeyer,et al.  Hospital Volume and Surgical Mortality in the United States , 2002 .

[12]  J. Birkmeyer,et al.  Regionalization of high-risk surgery and implications for patient travel times. , 2003, JAMA.

[13]  B. Hillner,et al.  Hospital and physician volume or specialization and outcomes in cancer treatment: importance in quality of cancer care. , 2000, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[14]  J. Birkmeyer,et al.  Surgeon volume and operative mortality in the United States. , 2003, The New England journal of medicine.

[15]  D. Urbach,et al.  Does it matter what a hospital is “high volume” for? Specificity of hospital volume-outcome associations for surgical procedures: analysis of administrative data* , 2004, Quality and Safety in Health Care.

[16]  A. Milstein,et al.  Large employers' new strategies in health care. , 2002, The New England journal of medicine.