The impact of hospital volume on clinical and economic outcomes in ventral hernia repair: an analysis with national policy implications

Chattha, Anmol; Muste, Justin; Patel, Ashit

doi:10.1007/s10029-018-1803-3

Cited by 19 publications

(7 citation statements)

References 18 publications

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“…A relationship between higher volumes and higher quality of care was also reported by Chukmaitov et al [23], who specifically studied the ITC sector in the US and found a weak association between volume and the number of 30-day unplanned hospitalisations. The volume-quality association was also confirmed by studies scrutinising high-volume and low-risk procedures [19–22, 24, 52], and by reviews including high-risk procedures [14–16]. However, one study from the UK that looked at three elective surgical procedures (hernia repair, hip replacement and knee replacement) found no association, or of no clinical significance, between volume and quality [18].…”

Section: Discussionmentioning

confidence: 93%

“…However, the contemporary debate regarding the volume-quality relationship focuses primarily on these high-risk, low-volume, inpatient procedures [17], and both low-risk, high-volume procedures and outpatient procedures have received much less attention in recent years. Some studies have examined the volume-quality relationship in low-risk, high-volume procedures but these have focused mainly on total knee and hip arthroplasty, and hernia repair surgery [15, 16, 18–22]. Moreover, almost all studies of the volume-quality relationship analyse inpatient hospital data and do not take into account care performed in outpatient settings [15–17].…”

Section: Introductionmentioning

confidence: 99%

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Is there a volume-quality relationship within the independent treatment centre sector? A longitudinal analysis

Kruse¹,

Amerongen

Borghans

et al. 2019

BMC Health Serv Res

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BackgroundThe number of independent treatment centres (ITCs) has grown substantially. However, little is known as to whether the volume-quality relationship exists within this sector and whether other possible organisational factors mediate this relationship. The aim of this study is to gain a better understanding of such possible relationships.MethodsData originate from the Dutch Health and Youth Care Inspectorate (IGJ) and the Dutch Patients Association. We used longitudinal data from 4 years (2014–2017) including three different quality measures: 1) composite of structural and process indicators, 2) postoperative infections, and 3) patient satisfaction. We measured volume by the number of invasive treatments. We adjusted for three important organisational characteristics: (1) size of workforce, (2) chain membership, and (3) ownership status. For statistical inference, random effects analysis was used. We also ran several robustness checks for the volume-quality relationship, including a fractional logit model.ResultsITCs with higher volumes scored better on structure, process and outcome (i.e. postoperative infections) indicators compared to the low-volume ITCs – although only marginally on outcome. However, ITCs with higher volumes do not have higher patient satisfaction. There is a decreasing marginal effect of volume – in other words, an L-shaped curve. The effect of the intermediating structural factors on the volume-quality relationship (i.e. workforce size, chain membership and ownership status) is less clear. Our findings suggest that chain membership has a negative influence on patient satisfaction. Furthermore, for-profit providers scored better on the Net Promoter Score.ConclusionsOur study shows with some certainty that the quality of care in low-volume ITCs is lower than in high-volume ITCs as measured by structural, process and outcome (i.e. postoperative infection) indicators. However, the size of the effect of volume on postoperative infections is small, and at higher volumes the marginal benefits (in terms of lower postoperative infections) decrease. In addition, volume is not related to patient satisfaction. Furthermore, the association between the structural intermediating factors and quality are tenuous.Electronic supplementary materialThe online version of this article (10.1186/s12913-019-4467-5) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Is there a volume-quality relationship within the independent treatment centre sector? A longitudinal analysis

Kruse¹,

Amerongen

Borghans

et al. 2019

BMC Health Serv Res

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“… 50 , 51 Previous research has demonstrated that high-volume hospitals provided better quality of care for low-risk invasive treatments. 50 , 52 - 54 One contribution from the United States and the Netherlands shows that the volume-quality relationship also persist within the ITC sector, however, this relationship appears to be weaker. 51 , 55 Different from the previous studies, our results do not indicate that a volume-quality relationship exists for the 5 treatments included in this study.…”

Section: Discussionmentioning

confidence: 99%

Independent Treatment Centres Are Not a Guarantee for High Quality and Low Healthcare Prices in The Netherlands – A Study of 5 Elective Surgeries

Tulp

Kruse

Stadhouders

et al. 2020

Int J Health Policy Manag

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Background: Independent treatment centres (ITCs) are a growing phenomenon in many healthcare systems. Focus factory theory predicts that ITCs provide high quality healthcare with low prices, through specialisation, high-volume and routine. This study examines if ITC care outperforms general hospital (GH) care within a regulated competition system in the Netherlands, by focusing on differences in healthcare quality and price. Methods: The cross-sectional study combined publicly available quality data, list prices and insurer contracts for 2017. Clinical outcomes of 5 elective surgeries (total hip and knee replacement, anterior cruciate ligament (ACL), cataract and carpal tunnel surgeries) were compared using zero-or-one inflated beta-regressions, corrected for underlying structural factors (ie, volume of care, process and structure indicators, and chain affiliation). Furthermore, price differences between ITCs and GHs were examined using ordinary least squares regressions. Lastly, we analysed quality of care in relation to the number of insurance contracts of the 4 largest Dutch insurance companies using ordered logistic regressions. Results: Quality differences between ITCs and GHs were found to be inconsistent across procedures. No facility type performed better overall. There were no differences exhibited in the list prices between ITCs and GHs. No consistent relationship was found between the underlying factors and quality or price, in different procedures and time. We found no indication for selective contracting based on quality within the ITC sector. Conclusions: This study found no evidence that ITCs outperform GHs on quality or price. This evidence does not support the focus factory theory. The substantial practice variation in quality of care may justify more evidence-based contracting within the market for elective surgery.

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“…In a study of the National Impatient Sample patients treated at high—volume hospitals with >60 ventral hernia repairs per year were less likely to experience a major complication (OR 0.88; 95% CI 0.82–0.96; p = 0.002) or wound-based complication (OR 0.84; 95% CI 0.76–0.92; p < 0.001) ( 75 ). The authors concluded, that hospitals performing larger numbers of ventral hernia repairs, despite caring for a more complex patient population, may be associated with better patient outcomes than lower volume hospitals ( 75 ).…”

Section: Surgeon Volumementioning

confidence: 99%

What Is the Influence of Simulation-Based Training Courses, the Learning Curve, Supervision, and Surgeon Volume on the Outcome in Hernia Repair?—A Systematic Review

Köckerling

2018

Front. Surg.

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Introduction: In hernia surgery, too, the influence of the surgeon on the outcome can be demonstrated. Therefore the role of the learning curve, supervised procedures by surgeons in training, simulation-based training courses and surgeon volume on patient outcome must be identified.Materials and Methods: A systematic search of the available literature was carried out in June 2018 using Medline, PubMed, and the Cochrane Library. For the present analysis 81 publications were identified as relevant.Results: Well-structured simulation-based training courses was found to be associated with a reduced perioperative complication rate for patients operated on by trainees. Open as well as, in particular, laparo-endoscopic hernia surgery procedures have a long learning curve. Its negative impact on the patient can be virtually eliminated through consistent supervision by experienced hernia surgeons. However, this presupposes availability of an adequate trainee caseload and of well-trained hernia surgeons and calls for a certain degree of centralization in hernia surgery.Conclusion: Training courses, learning curve, supervision, and surgeon volume are important aspects in training and outcomes in hernia surgery.

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The impact of hospital volume on clinical and economic outcomes in ventral hernia repair: an analysis with national policy implications

Cited by 19 publications

References 18 publications

Is there a volume-quality relationship within the independent treatment centre sector? A longitudinal analysis

Is there a volume-quality relationship within the independent treatment centre sector? A longitudinal analysis

Independent Treatment Centres Are Not a Guarantee for High Quality and Low Healthcare Prices in The Netherlands – A Study of 5 Elective Surgeries

What Is the Influence of Simulation-Based Training Courses, the Learning Curve, Supervision, and Surgeon Volume on the Outcome in Hernia Repair?—A Systematic Review

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