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Published on: January 12, 2024
On the Hospital Volume and Outcome Relationship: Does Specialization Matter More Than Volume?
Kris C L Lee1,2, Kannan Sethuraman3, Jongsay Yong2
1Golden Dragon Centre, City University of Macau, Macau, China.
Objective:
To evaluate the relationship between hospital volume and outcome by focusing on alternative measures of volume that capture specialization and overall throughput of hospitals.
Data Sources/Study Setting:
Hospital administrative data from the state of Victoria, Australia; data contain 1,798,474 admitted episodes reported by 135 public and private acute-care hospitals.
Study Design:
This study contrasts the volume-outcome relationship using regression models with different measures of volume; two-step and single-step risk-adjustment methods are used.
Data Collection/Extraction Methods:
The sample is restricted to ischemic heart disease (IHD) patients (ICD-10 codes: I20-I25) admitted during 2001/02 to 2004/05.
Principal Findings:
Overall hospital throughput and degree of specialization display more substantive implications for the volume-outcome relationship than conventional caseload volume measure. Two-step estimation when corrected for heteroscedasticity produces comparable results to single-step methods.
Conclusions:
Different measures of volume could lead to vastly different conclusions about the volume-outcome relationship. Hospital specialization and throughput should both be included as measures of volume to capture the notion of size, focus, and possible congestion effects.
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