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High-quality healthcare, such as coronary artery bypass graft surgery, may not always be more expensive. Hospital volume is not the sole determinant of superior patient outcomes.
Area of Science:
- Cardiovascular Surgery
- Health Services Research
- Quality Improvement
Background:
- The healthcare quality movement often assumes superior care is less costly.
- High-volume hospitals are frequently presumed to provide higher quality care.
- The relationship between cost, volume, and outcomes in complex procedures requires further investigation.
Purpose of the Study:
- To examine the relationship between hospital volume, cost, and quality of care for coronary artery bypass graft (CABG) surgeries.
- To identify common factors among hospitals achieving superior outcomes in CABG procedures.
- To challenge the conventional wisdom that best care always costs less.
Main Methods:
- Analysis of Medicare data for coronary artery bypass graft surgeries.
- Comparative study of hospital performance based on volume and outcomes.
- Identification of common denominators in high-performing hospitals.
Main Results:
- The assumption that best care is always less expensive was challenged.
- High volume was often associated with higher quality, but low volume did not preclude superior outcomes.
- Specific common factors were identified in hospitals with consistently superior CABG outcomes.
Conclusions:
- Healthcare quality and cost are not always inversely related.
- Hospital volume is an important but not exclusive predictor of surgical quality.
- Understanding the characteristics of high-performing hospitals can inform quality improvement initiatives.
Abstract:
Contrary to a key legend of the healthcare quality movement, the best care doesn't always cost less. And while high volume often does lead to higher quality, low volume doesn't necessarily preclude it. Those are among the findings from a study of Medicare data on coronary artery bypass graft surgeries. Researchers found some common denominators among hospitals that consistently achieved superior outcomes in the procedures.