A wealth of medical literature suggests hospitals that perform higher numbers of complex operations have lower patient mortality rates. Researchers from Rice University in Houston highlight the possible flaws of these assertions in a new study published in Applied Health Economics and Health Policy.
For the study, researchers analyzed hospital patient discharge data from three states — Florida, New Jersey and New York. They also examined information from the American Hospital Association Annual Survey of Hospitals from 2000 to 2011. The study's authors focused on six major cancer operations and used three different statistical frameworks to examine the correlation between patient mortality and hospital volume. Many previous studies have used less comprehensive statistical models, which — the study's authors suggest — cannot account for other factors that could drive both high volume and better outcomes.
Researchers found that while the simplest model, a logistic regression, could display evidence that high hospital volume could be related to lower mortality rates in all six of the examined procedures, more advanced statistical modeling that adjusts for biases shows that only four operations displayed such an effect between volume and mortality.
"The medical literature may be overemphasizing the role that hospital volume plays in patient outcomes," Vivian Ho, PhD, chair in health economics at Rice's Baker Institute for Public Policy and study co-author, said. "Traveling to a high-volume hospital could be costly and hard on both the patient and family. Even some patients living in a large city may prefer their nearby community hospital to a large medical center 20 or 30 miles away."
More studies are needed to re-evaluate the volume-outcome effect, the study's authors noted.
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