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[The relationship between provider volume and mortality rate: volume data of German centres of excellence]
1Institut für Gesundheitsökonomie und Klinische Epidemiologie Universität zu Köln Gleueler Str. 176-178 50935 Köln, Germany.
Insights
Most German centers of excellence (COEs) met volume thresholds for better outcomes. Exceptions included carotid endarterectomy and liver transplantation, suggesting a need for Germany-specific volume-outcome studies.
Area of Science:
- Healthcare quality assessment
- Surgical outcomes research
- Health services research
Background:
- Establishing volume-outcome relationships is crucial for healthcare quality.
- Identifying centers of excellence (COEs) requires defined performance metrics.
- Previous studies suggest higher surgical volumes correlate with lower mortality rates.
Purpose of the Study:
- To assess the proportion of German COEs meeting volume thresholds linked to reduced mortality.
- To evaluate hospital and surgeon volumes for specific diagnoses and interventions in Germany.
- To identify specialties with low adherence to volume thresholds.
Main Methods:
- Systematic literature review to identify relevant volume-threshold studies.
- Questionnaire-based survey of German COEs regarding 1999 surgical/diagnostic volumes.
- Analysis of hospital department and physician (median, senior consultant) volumes.
Main Results:
- Most COEs exceeded volume thresholds for selected procedures (>50%).
- Carotid endarterectomy and liver transplantation showed lower COE adherence to thresholds.
- Physician performance met standards in most cases, with exceptions in specific complex procedures.
Conclusions:
- While many German COEs meet volume thresholds, specific areas like cardiac surgery and transplantation lag.
- Potential reasons for lower volumes include oversupply of centers and lack of high-referral regional hubs.
- Further Germany-specific volume-outcome studies are recommended, especially for low-volume specialties.
Abstract:
The purpose of this study was to determine the percentage of centres of excellence (COEs) in Germany that achieved, for selected diagnoses and interventions, annual hospital or surgeon threshold volumes associated with a lower mortality rate. A systematic review and evaluation of the literature identified the most relevant study for each diagnosis and intervention selected. Each diagnosis and intervention was only considered if the most relevant source yielded a threshold volume associated with a reduced mortality rate. COEs received questionnaires on the annual volume of such diagnoses and interventions for each department, providing physician (median), and senior consultant in 1999. For most of the diagnoses and interventions considered, the percentage of COEs meeting their respective threshold volumes exceeded 50%. Exceptions were carotid endarterectomy (performed in departments of general cardiac surgery) and liver transplantation. The percentage of providing physicians and senior consultants performing to the desired standard remained above 75% for most of the diagnoses and interventions. Exceptions were surgeons dealing with carotid endarterectomy, correcting congenital heart disease (both performed in departments of general cardiac surgery), and correcting primary hyperparathyroidism. That a smaller percentage of centres for general cardiac surgery, liver transplantation, and primary hyperparathyroidism operates at their threshold volumes may be due to a relative oversupply of centres specialising in these treatments as well as a the lack of regional centres with a high referral rate. Due to the country-specificity of studies performed on the relationship between volume and mortality rate, it is highly recommended that Germany-specific volume-outcome studies be performed particularly in specialties with relatively low case volumes.