Skip to main content
Sister Publication Links
  • ESG: THE NEW IMPERATIVE
Subscribe
  • My Account
  • Login
  • Subscribe
  • News
    • Current News
    • COVID-19
    • Providers
    • Insurance
    • Government
    • Finance
    • Technology
    • Safety & Quality
    • Transformation
    • People
    • Regional News
    • Digital Edition (Web Version)
    • Patients
    • Operations
    • Care Delivery
    • Payment
    • Midwest
    • Northeast
    • South
    • West
  • Digital Health
  • Insights
    • ACA 10 Years After
    • Best Practices
    • Special Reports
    • Innovations
  • Data/Lists
    • Rankings/Lists
    • Interactive Databases
    • Data Points
  • Op-Ed
    • Bold Moves
    • Breaking Bias
    • Commentaries
    • Letters
    • Vital Signs Blog
    • From the Editor
  • Awards
    • Nominate/Eligibility
    • 100 Most Influential People
    • 50 Most Influential Clinical Executives
    • Best Places to Work in Healthcare
    • Excellence in Governance
    • Health Care Hall of Fame
    • Healthcare Marketing Impact Awards
    • Top 25 Emerging Leaders
    • Top 25 Innovators
    • Diversity in Healthcare
    • Women in Healthcare
    • - Luminaries
    • - Top 25 Diversity Leaders
    • - Leaders to Watch
    • - Luminaries
    • - Top 25 Women Leaders
    • - Women to Watch
  • Events
    • Conferences
    • Galas
    • Virtual Briefings
    • Webinars
    • Custom Media Event: ESG Summit
    • Transformation Summit
    • Women Leaders in Healthcare Conference
    • Social Determinants of Health Symposium
    • Leadership Symposium
    • Health Care Hall of Fame Gala
    • Top 25 Women Leaders Gala
    • Best Places to Work Awards Gala
    • Top 25 Diversity Leaders Gala
    • - Hospital of the Future
    • - Value Based Care
    • - Supply Chain Revenue Cycle
    • - Hospital at Home
    • - Workplace of the Future
    • - Strategic Marketing
    • - Virtual Health
  • Listen
    • Podcast - Next Up
    • Podcast - Beyond the Byline
    • Sponsored Podcast - Healthcare Insider
    • Video Series - The Check Up
    • Sponsored Video Series - One on One
  • MORE +
    • Advertise
    • Media Kit
    • Newsletters
    • Jobs
    • People on the Move
    • Reprints & Licensing
MENU
Breadcrumb
  1. Home
  2. Safety & Quality
April 27, 2016 01:00 AM

Blog: Are high-volume facilities better? It depends on how you analyze it

Sabriya Rice
  • Tweet
  • Share
  • Share
  • Email
  • More
    Reprints Print

    It's often said that death rates and costs are lower and outcomes are better at facilities that perform high volumes of a procedure. But a report this week challenges that assumption and says more research is needed.

    Clinicians are using a flawed statistical model to correlate volume and outcome, according to a study in the journal Applied Health Economics and Health Policy.

    Hospital-specific factors that could affect outcomes are ignored in many models, and not every type of surgery is riskier at a low-volume facility, said Vivian Ho, a health economist at Rice University's Baker Institute for Public Policy.

    She and researchers from Baylor College of Medicine in Houston warned that pushing surgical patients to high-volume centers could lead to unintended consequences, such as less marketplace competition.

    The study used hospital discharge data for more than 164,000 patients who underwent six types of major cancer surgery in Florida, New Jersey and New York between 2000 and 2011.

    They looked at the relationship between volume and mortality following these surgeries using three statistical models: logistic regression, random-effects and fixed-effects.

    The first one, the most simple and frequently used in clinical journals, does not account for potentially unobserved hospital-specific factors that could be affecting outcomes, as do the other two models.

    According to the analysis, no matter what model was used, there was no relationship between doing more esophagus cancer surgeries and lower mortality. However, on two of the three models studied, there was a significant correlation between how many colon and lung cancer surgeries were performed and better outcomes.

    For the fixed-effects model, the most complicated statistical model that takes into account more unobserved factors, there “was no volume effect anywhere,” Ho noted.

    The medical literature may overemphasize the role that hospital volume plays in patient outcomes, and could mislead physicians looking for evidence on where to send patients, the researchers said.

    Factors such as organizational structure, culture or infection policies can impact surgical outcomes.

    This week's analysis comes as healthcare policy, quality and safety leaders point to studies that show high-volume hospitals tend to have overall better outcomes and lower costs.

    For example, a 2015 analysis found that more than 60% of patients undergoing cancer surgery in California went to a low-volume facility, even when a high-volume facility was within 50 miles. That report said low-volume facilities had longer lengths of stay, higher postoperative complications and a greater number of patients readmitted for follow-up care.

    Some are calling for hospitals to face tougher scrutiny before they launch new surgical specialty programs, and others would like to regionalize where patients are sent for certain high-risk surgeries.

    A few notable health systems are taking what they call “volume pledges,” where they plan to cut back on surgeries at low-volume locations.

    The Joint Commission, the Oakbrook Terrace, Ill.-based hospital accreditation organization, declined to comment, calling the study “a complex methodological paper that is probably best left to statisticians to discuss.”

    However, the group is critical of volume pledges and its president, Mark Chassin, recently told Kaiser Health News that volume should never be used as a measure of quality because the measure is imperfect.

    Statisticians from U.S. News & World Report, a group that provides healthcare quality ratings and recently began looking into outcomes of common high-volume surgeries and procedures, said this week's study raises several interesting points, including why volume is surfacing as an important topic.

    “So volume does appear to be relevant in most instances,” said Geoff Dougherty, the senior health services researcher who conducts statistical modeling for U.S. News. “Shifting patients away from low-volume hospitals could improve outcomes, even if volume does not cause quality.”

    Letter
    to the
    Editor

    Send us a letter

    Have an opinion about this story? Click here to submit a Letter to the Editor, and we may publish it in print.

    Recommended for You
    monkeypox
    WHO panel: Monkeypox not a global emergency 'at this stage'
    COVID vaccines saved 20M lives in 1st year, scientists say
    COVID vaccines saved 20M lives in 1st year, scientists say
    Sponsored Content
    Get Newsletters

    Sign up for enewsletters and alerts to receive breaking news and in-depth coverage of healthcare events and trends, as they happen, right to your inbox.

    Subscribe Today
    MH Magazine Cover

    MH magazine offers content that sheds light on healthcare leaders’ complex choices and touch points—from strategy, governance, leadership development and finance to operations, clinical care, and marketing.

    Subscribe
    Connect with Us
    • LinkedIn
    • Twitter
    • Facebook
    • RSS

    Our Mission

    Modern Healthcare empowers industry leaders to succeed by providing unbiased reporting of the news, insights, analysis and data.

    Contact Us

    (877) 812-1581

    Email us

     

    Resources
    • Contact Us
    • Advertise with Us
    • Ad Choices Ad Choices
    • Sitemap
    Editorial Dept
    • Submission Guidelines
    • Code of Ethics
    • Awards
    • About Us
    Legal
    • Terms and Conditions
    • Privacy Policy
    • Privacy Request
    Modern Healthcare
    Copyright © 1996-2022. Crain Communications, Inc. All Rights Reserved.
    • News
      • Current News
      • COVID-19
      • Providers
      • Insurance
      • Government
      • Finance
      • Technology
      • Safety & Quality
      • Transformation
        • Patients
        • Operations
        • Care Delivery
        • Payment
      • People
      • Regional News
        • Midwest
        • Northeast
        • South
        • West
      • Digital Edition (Web Version)
    • Digital Health
    • Insights
      • ACA 10 Years After
      • Best Practices
      • Special Reports
      • Innovations
    • Data/Lists
      • Rankings/Lists
      • Interactive Databases
      • Data Points
    • Op-Ed
      • Bold Moves
      • Breaking Bias
      • Commentaries
      • Letters
      • Vital Signs Blog
      • From the Editor
    • Awards
      • Nominate/Eligibility
      • 100 Most Influential People
      • 50 Most Influential Clinical Executives
      • Best Places to Work in Healthcare
      • Excellence in Governance
      • Health Care Hall of Fame
      • Healthcare Marketing Impact Awards
      • Top 25 Emerging Leaders
      • Top 25 Innovators
      • Diversity in Healthcare
        • - Luminaries
        • - Top 25 Diversity Leaders
        • - Leaders to Watch
      • Women in Healthcare
        • - Luminaries
        • - Top 25 Women Leaders
        • - Women to Watch
    • Events
      • Conferences
        • Transformation Summit
        • Women Leaders in Healthcare Conference
        • Social Determinants of Health Symposium
        • Leadership Symposium
      • Galas
        • Health Care Hall of Fame Gala
        • Top 25 Women Leaders Gala
        • Best Places to Work Awards Gala
        • Top 25 Diversity Leaders Gala
      • Virtual Briefings
        • - Hospital of the Future
        • - Value Based Care
        • - Supply Chain Revenue Cycle
        • - Hospital at Home
        • - Workplace of the Future
        • - Strategic Marketing
        • - Virtual Health
      • Webinars
      • Custom Media Event: ESG Summit
    • Listen
      • Podcast - Next Up
      • Podcast - Beyond the Byline
      • Sponsored Podcast - Healthcare Insider
      • Video Series - The Check Up
      • Sponsored Video Series - One on One
    • MORE +
      • Advertise
      • Media Kit
      • Newsletters
      • Jobs
      • People on the Move
      • Reprints & Licensing