Related Experiment Video
Updated: Jul 12, 2026
05:23
Continuous Manual Exchange Transfusion for Patients with Sickle Cell Disease: An Efficient Method to Avoid Iron Overload
Published on: March 14, 2017
Selective referral to high-volume hospitals: estimating potentially avoidable deaths
R A Dudley1, K L Johansen, R Brand
1Department of Medicine, School of Medicine, and the Institute for Health Policy Studies, University of California, San Francisco, 94118, USA. adudley@itsa.ucsf.edu
JAMA
|March 7, 2000
Summary
Referring patients to high-volume hospitals (HVHs) can significantly reduce mortality for complex conditions. In California, an estimated 602 deaths could be avoided annually by directing care to HVHs.
Area of Science:
- Healthcare outcomes research
- Health services research
- Surgical outcomes analysis
Background:
- Evidence suggests high-volume hospitals (HVHs) have lower mortality rates than low-volume hospitals (LVHs) for specific procedures.
- Despite this evidence, referral of patients to HVHs remains limited in practice.
- This gap highlights a need to investigate the potential benefits of increased HVH utilization.
Purpose of the Study:
- To quantify the difference in hospital mortality between HVHs and LVHs for conditions with robust data.
- To estimate the number of deaths in California that could be prevented by referring patients to HVHs.
Main Methods:
- A comprehensive literature search (1983-1998) identified studies on hospital volume and mortality.
- The highest-quality study for each condition was selected to calculate odds ratios (ORs) for in-hospital mortality.
- These ORs were applied to the 1997 California hospital discharge database to estimate avoidable deaths.
Main Results:
- Mortality was significantly lower at HVHs for 11 complex conditions, including various surgeries and HIV/AIDS treatment.
- In California, 58,306 patients with these conditions were treated at LVHs in 1997.
- An estimated 602 deaths (95% CI, 304-830) at LVHs were attributable to low hospital volume.
Conclusions:
- Facilitating patient referral to HVHs offers a significant potential to reduce overall hospital mortality in California for identified conditions.
- Further research is necessary to assess the feasibility of selective referral strategies and their potential consequences.
More Related Videos
06:55Inverse Probability of Treatment Weighting (Propensity Score) using the Military Health System Data Repository and National Death Index
Published on: January 8, 2020
06:46Competing-Risk Nomogram for Predicting Cancer-Specific Survival in Multiple Primary Colorectal Cancer Patients after Surgery
Published on: September 27, 2024
Related Concept Videos
01:26Methods Of Healthcare Delivery System
At the different levels of the healthcare system, we see varying methods of healthcare used. These methods include managed care systems, case management, and primary healthcare.
Managed Care System:
The managed care system is designed to control the cost while maintaining the quality of care. The patient's care from admission to discharge is planned by the primary care provider or the case manager, also known as the gatekeeper. In a managed care system, the number of care providers is limited...
Managed Care System:
The managed care system is designed to control the cost while maintaining the quality of care. The patient's care from admission to discharge is planned by the primary care provider or the case manager, also known as the gatekeeper. In a managed care system, the number of care providers is limited...
01:28Hospitals-I
Hospitals offer medical and surgical care to the sick and injured, along with accommodation while they recover. At the same time, they also provide outpatient, emergency, psychiatric, and rehabilitation services to meet various community needs. In addition to providing medical care, hospitals also act as hubs for medical research and training. Hospitals use clinical procedures and evidence-based practice standards to deliver patient care. To deliver safe and efficient care, a nurse must stay up...
01:22Life Tables
A life table is a statistical tool that summarizes the mortality and survival patterns of a population, providing detailed insights into the likelihood of survival or death across different age intervals within a cohort. By organizing data on survival probabilities and mortality rates, life tables offer a clear snapshot of population dynamics over time. They are extensively used in demography, public health, actuarial science, and ecology to analyze life expectancy, design health interventions,...
01:20Actuarial Approach
The actuarial approach, a statistical method originally developed for life insurance risk assessment, is widely used to calculate survival rates in clinical and population studies. This method accounts for participants lost to follow-up or those who die from causes unrelated to the study, ensuring a more accurate representation of survival probabilities.
Consider the example of a high-risk surgical procedure with significant early-stage mortality. A two-year clinical study is conducted,...
Consider the example of a high-risk surgical procedure with significant early-stage mortality. A two-year clinical study is conducted,...
01:09Censoring Survival Data
Survival analysis is a statistical method used to analyze time-to-event data, often employed in fields such as medicine, engineering, and social sciences. One of the key challenges in survival analysis is dealing with incomplete data, a phenomenon known as "censoring." Censoring occurs when the event of interest (such as death, relapse, or system failure) has not occurred for some individuals by the end of the study period or is otherwise unobservable, and it might have many different reasons...
01:28Kidney Transplant I: Introduction
A kidney transplant is a surgical approach that involves replacing a non-functioning kidney with a healthy one from a donor. This procedure is often a treatment option for end-stage renal disease (ESRD) patients. The method requires careful recipient selection, including evaluating various medical and psychosocial factors. These criteria vary between transplant centers but generally include assessments of the patient's overall health, adherence to medical recommendations, and lifestyle...