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Quantity and quality relationships in cardiovascular medicine
1Cardiology Department, Oslo University Hospital Ullevål, Norway.
Insights
Hospital and physician experience significantly impacts surgical quality for many procedures, but not consistently for acute myocardial infarction. Setting minimum procedure volumes is suggested to improve care and discourage low-volume centers from complex interventions.
Area of Science:
- Cardiovascular Surgery
- Health Services Research
Background:
- Hospital and operator volume are known quality indicators for various surgical procedures.
- Evidence for the impact of volume on acute myocardial infarction treatment quality is less consistent.
- Nordic countries face challenges with small hospitals potentially hindering learning curve progression.
Purpose of the Study:
- To review the impact of hospital and operator volume on surgical quality.
- To evaluate the consistency of volume-outcome relationships across different cardiovascular interventions.
- To propose strategies for improving quality in low-volume settings.
Main Methods:
- Literature review of studies examining hospital and operator volume in cardiovascular procedures.
- Analysis of data consistency for volume-outcome relationships.
- Synthesis of findings to inform policy recommendations.
Main Results:
- Documented impact of volume on aortic surgery, bypass surgery, angioplasty, and arrhythmia ablation quality.
- Inconsistent data regarding volume's effect on acute myocardial infarction treatment.
- Small hospital sizes in Nordic countries may prevent reaching optimal learning curve plateaus.
Conclusions:
- Minimum procedure volume requirements for hospitals and physicians are recommended for complex interventions.
- Implementing volume thresholds could discourage low-volume centers from performing high-risk procedures.
- Standardizing volume metrics may enhance overall quality of cardiovascular care.
Abstract:
Hospital volume and often also operator volume have documented impacts on the quality of care for aortic and aortocoronary bypass surgery, for percutaneous angioplasty and for radiofrequency ablation for arrhythmias, whereas data are less consistent for treatment of acute myocardial infarction. A review of this research is given. In the Nordic countries hospitals are small, and often the plateau of the learning curve cannot be reached. To discourage low-volume centers from embarking upon too complicated interventional or surgical procedures, the author suggests that a minimal number should be set for certain major procedures, both for hospitals and for physicians.