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How is Volume Related to Quality in Health Care?
Pages 4-9

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From page 4...
... Regulators could also require that volume data be reported and, in turn, made available to consumers. Accrediting Organizations Organizations such as the Joint Commission on Accreditation of Healthcare Organizations could consider volume in accrediting hospitals and other health care institutions.
From page 5...
... is associated with better health outcomes. The uniformity with which the published research documents or confirms the existence of this association is compelling (although the review authors caution that a publication bias against negative findings cannot be ruled out)
From page 6...
... For example, if the difference between high- and low-volume hospitals' surgical mortality rates was only ~ or 2 percentage points, and the underlying condition for which the surgery was performed had a poor long-te~n prognosis, it may not be prudent to implement policy based only on a statistically significant difference in short-term mortality. The authors caution that they may not have identified all relevant studies of the relationship between volume and outcome and that many studies, particularly those involving cardiovascular procedures, were conducted in New York and thus may not generalize to states with less regulation of such procedures.
From page 7...
... Surgeons with low volume can include those who are newly trained, but may have state-of-the-art skills, as well as surgeons with years of experience and good outcomes who are reducing their work load before retirement. The quality of available data systems is central to monitoring the quality of health care, and Dr.
From page 8...
... Dr. Begg also described the difficulties of accurately assessing patient selection factors with available data (e.g., frailty is not necessarily captured in administrative data beyond lists of comorbid conditions)
From page 9...
... Halm, the literature review suggested that risk adjustment, although important, did not greatly affect the magnitude of the association between volume and outcome. The second application is to provide information to individual providers of care as part of a quality improvement program or to inform consumers of the volume or out .

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