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The volume-outcome relationship: practice-makes-perfect or selective-referral patterns?
Health Services Research
|June 1, 1987
Summary
Hospital patient volume impacts mortality rates. Both increased physician expertise from more cases ("practice-makes-perfect") and patient preference for high-performing hospitals ("selective-referral pattern") contribute to better outcomes.
Area of Science:
- Healthcare Management
- Health Services Research
- Medical Economics
Background:
- Studies indicate a correlation between higher hospital patient volume and lower mortality rates for specific diagnoses/procedures.
- This association has led to two primary hypotheses: practice-makes-perfect and selective-referral patterns.
Purpose of the Study:
- To investigate the validity of the practice-makes-perfect and selective-referral pattern hypotheses.
- To determine the relative importance of each hypothesis across different patient categories.
Main Methods:
- Analysis of data from over 900 hospitals across 17 patient categories.
- Utilized a simultaneous-equation model to assess the interplay between hospital volume, physician skill, and patient referral.
Main Results:
- Evidence supports both the practice-makes-perfect and selective-referral pattern hypotheses.
- The relative contribution of each hypothesis varies significantly depending on the specific diagnosis or procedure.
Conclusions:
- Both increased physician experience and patient selection contribute to improved hospital outcomes.
- Understanding these dynamics is crucial for optimizing healthcare delivery and patient care strategies.