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Defining minimum volume thresholds to increase quality of care: a new patient-oriented approach using mixed integer
Justus F A Vogel1, Max Barkhausen2, Christoph M Pross3
1School of Medicine, Chair of Health Care Management, University of St. Gallen, St. Jakob-Strasse 21, 9000, St. Gallen, Switzerland. justus.vogel@unisg.ch.
Implementing minimum volume regulation (MVR) can improve healthcare quality by concentrating treatments. Our model optimizes MVR thresholds, balancing patient outcomes with access and hospital capacity for better surgical care.
Area of Science:
- Health Services Research
- Health Policy
- Surgical Outcomes
Background:
- A positive association between treatment volume and patient outcomes is established for many surgical procedures.
- Current minimum volume regulation (MVR) policies have shown limited success due to inadequate consideration of outcome gains, patient travel time, and hospital capacity.
Purpose of the Study:
- To develop and apply a mixed integer programming model for optimizing minimum volume thresholds.
- To balance the utility of outcome quality gains with the feasibility of patient travel time and hospital capacity utilization.
Main Methods:
- A mixed integer programming model was developed to determine optimal minimum volume thresholds.
- The model was applied to the German hospital sector, analyzing four specific surgical procedures.
Main Results:
- Recommended minimum volume thresholds: 125 for cholecystectomy, 45 (colon) and 25 (rectum) for resections, 32 for prostatectomy, and 60 for knee arthroplasty.
- Optimized MVR could prevent 287 to 977 complications, representing 11.7% to 11.9% of total complications, depending on the procedure.
Conclusions:
- The developed model provides a framework for policy makers to effectively implement MVR.
- Optimizing MVR based on procedure-specific data can significantly improve healthcare quality by concentrating treatment delivery.
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