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Chiropractic Research Review

Hospitals: Higher Patient Volume Means Better Outcomes?

Publication of hospital-specific results and selective referral initiatives are infrequent in the current health care market. Evidence suggests that high-volume hospitals (HVHs) have lower mortality rates than low-volume hospitals (LVHs) for certain conditions, yet little attempt has been made to increase referral rates to HVHs.

To illustrate the potential benefit from instituting such a referral process, this study compared hospital mortality rates at HVHs and LVHs for various conditions and estimated the number of deaths (in California) that could potentially be avoided by increased referral to HVHs.

Seventy-two articles were identified through a literature search and grouped by condition (procedure and diagnosis).

Results showed that mortality rates were significantly lower at HVHs compared with LVHs for the following conditions:

* elective abdominal aortic aneurysm repair;
* carotid endarterectomy;
* lower extremity arterial bypass surgery;
* coronary artery bypass surgery;
* coronary angioplasty;
* heart transplantation;
* pediatric cardiac surgery;
* pancreatic cancer surgery;
* esophageal cancer surgery;
* cerebral aneurysm surgery; and
* treatment of HIV/AIDS.

A total of 58,306 of 121,609 patients with these conditions were admitted to LVHs in California (1997). The authors estimate that 602 deaths at LVHs could have been prevented if cases had been referred to HVHs, and suggest the implementation of intitiatives to facilitate referral of patients with these conditions to HVHs.

Dudley RA, Johansen KL, Brand R, et al. Selective referral to high-volume hospitals. Estimating potentially avoidable deaths. Journal of the American Medical Association, March 1, 2000:283(9), pp1159-66.

Chiropractic Research Review

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