High volume hospitals (HVHs) have lower mortality than low volume hospitals (LVHs) for certain conditions. However, few employers, health plans, or government programs have initiated efforts to selectively refer patients to HVHs.
Objective: To determine the difference in hospital mortality between HVHs and LVHs for conditions for which high quality data exist, to estimate how many deaths potentially could be avoided in California by referral to HVHs.
Methods: Medline, Current Contents, and FirstSearch Social Abstracts were searched using key words: hospital, outcome, mortality, volume, risk, and quality. The highest quality study assessing the volume-mortality relationship was identified for each condition. The odds ratios for LVH vs. HVH mortality from these studies were applied to 1997 California hospital data to estimate potentially avoidable deaths.
Results: The best studies found that mortality was significantly lower at HVHs for abdominal aortic aneurysm repair, carotid endarterectomy, lower extremity bypass, coronary bypass, coronary angioplasty, heart transplant, pediatric cardiac surgery, pancreatic and esophageal cancer surgery, cerebral aneurysm surgery, and HIV/AIDS. 58,306 of 121,609 patients with these conditions were admitted to California LVHs in 1997. We estimated that 602 deaths (95% CI 304-830) at LVHs were attributable to their low volume.
Conclusions: Initiatives to selectively refer patients to HVHs might reduce overall hospital mortality. Realizing a reduction in mortality, however, may be limited by difficulties transferring patients to HVHs, loss of continuity of care, and reduced access to specialists for patients remaining at LVHs. Further study is needed to determine if selective referral is feasible and appropriate.
Learning Objectives: At the conclusion of the session, the participant (learner) in this session will be able to: 1.List the procedures and diagnoses for which good evidence exists that high volume hospitals have lower mortality than low volume hospitals. 2.Calculate the number of potentially avoidable deaths due to admission to low volume hospitals in any state or region with a hospital dischage database. 3.Articulate the potential barriers to referral to high volume hospitals and their effect on the ability to realize the mortality reductions associated with referral
Keywords: Hospitals, Health Care Quality
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.