Quality Wrapped in Volume Inside a Hospital
Authors: Peter B. Bach
Journal: Annals of Internal Medicine (2009)

Editorials19 May 2009Quality Wrapped in Volume Inside a HospitalPeter B. Bach, MD, MAPPPeter B. Bach, MD, MAPPFrom Memorial Sloan-Kettering Cancer Center, New York, NY 10065.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-150-10-200905190-00013 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Studies that documented surgical outcome differences proliferated in the late 1990s. High-volume hospitals (that is, those that performed larger numbers of a particular procedure) tended to have better outcomes than their lower-volume peers (1). Nested within these findings was a similar volume–outcome relationship for surgeons (2). When low- and high-volume hospitals were compared, some outcome gaps were very large. Begg and colleagues (3) reported a 14% absolute difference in 30-day mortality rates among patients who had esophagectomy for esophageal cancer. Other gaps were modest. Schrag and coworkers (4) reported a 2% absolute difference in mortality rates 30 days after colorectal ...References1. Halm EA, Lee C, Chassin MR. Is volume related to outcome in health care? A systematic review and methodologic critique of the literature. Ann Intern Med. 2002;137:511-20. [PMID: 12230353] LinkGoogle Scholar2. Birkmeyer JD, Siewers AE, Marth NJ, Goodman DC. Regionalization of high-risk surgery and implications for patient travel times. JAMA. 2003;290:2703-8. [PMID: 14645312] CrossrefMedlineGoogle Scholar3. Begg CB, Cramer LD, Hoskins WJ, Brennan MF. Impact of hospital volume on operative mortality for major cancer surgery. JAMA. 1998;280:1747-51. [PMID: 9842949] CrossrefMedlineGoogle Scholar4. Schrag D, Cramer LD, Bach PB, Cohen AM, Warren JL, Begg CB. Influence of hospital procedure volume on outcomes following surgery for colon cancer. JAMA. 2000;284:3028-35. [PMID: 11122590] CrossrefMedlineGoogle Scholar5. Peterson ED, Coombs LP, DeLong ER, Haan CK, Ferguson TB. Procedural volume as a marker of quality for CABG surgery. JAMA. 2004;291:195-201. [PMID: 14722145] CrossrefMedlineGoogle Scholar6. Hewitt M. Interpreting the Volume-Outcome Relationship in the Context of Health Care Quality. Washington, DC: National Academy Pr; 2000. Google Scholar7. Birkmeyer JD, Finlayson EV, Birkmeyer CM. Volume standards for high-risk surgical procedures: potential benefits of the Leapfrog initiative. Surgery. 2001;130:415-22. [PMID: 11562662] CrossrefMedlineGoogle Scholar8. Bach PB, Cramer LD, Schrag D, Downey RJ, Gelfand SE, Begg CB. The influence of hospital volume on survival after resection for lung cancer. N Engl J Med. 2001;345:181-8. [PMID: 11463014] CrossrefMedlineGoogle Scholar9. Auerbach AD, Hilton JF, Maselli J, Pekow PS, Rothberg MB, Lindenauer PK. Shop for quality or volume? Volume, quality, and outcomes of coronary artery bypass surgery. Ann Intern Med. 2009;150:696-704. LinkGoogle Scholar10. Sehgal AR. Impact of quality improvement efforts on race and sex disparities in hemodialysis. JAMA. 2003;289:996-1000. [PMID: 12597751] CrossrefMedlineGoogle Scholar11. Bach PB, Guadagnoli E, Schrag D, Schussler N, Warren JL. Patient demographic and socioeconomic characteristics in the seer-medicare database applications and limitations. MedCare. 2002;40 8 Suppl 19-25. [PMID: 12187164] MedlineGoogle Scholar12. Rosenthal MB. Nonpayment for performance? Medicare's new reimbursement rule. N Engl J Med. 2007;357:1573-5. [PMID: 17942869] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Memorial Sloan-Kettering Cancer Center, New York, NY 10065.Disclosures:Other: Member of the Committee on Performance Measurement of the National Committee for Quality Assurance.Corresponding Author: Peter B. Bach, MD, MAPP, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, Box 221, New York, NY 10065. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoShop for Quality or Volume? Volume, Quality, and Outcomes of Coronary Artery Bypass Surgery Andrew D. Auerbach , Joan F. Hilton , Judith Maselli , Penelope S. Pekow , Michael B. Rothberg , and Peter K. Lindenauer Metrics Cited byDo We Continue to Unnecessarily Perform Ipsilateral Adrenalectomy at the Time of Radical Nephrectomy? A Population Based StudyStrategy, Structure, and Patient Quality Outcomes in Ambulatory Surgery Centers (1997-2004)Commentary: Improving Medical Education During Financially Challenging Times 19 May 2009Volume 150, Issue 10Page: 729-730KeywordsCoronary artery bypass graftingDeath ratesHealth care qualityPatient advocacyPatientsQuality improvementSurgeonsSurgery ePublished: 19 May 2009 Issue Published: 19 May 2009 Copyright & PermissionsCopyright © 2009 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...