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Related Experiment Videos

The volume-outcome relationship: practice-makes-perfect or selective-referral patterns?

H S Luft, S S Hunt, S C Maerki

    Health Services Research
    |June 1, 1987
    PubMed
    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.

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    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.

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    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.