Volume-outcome relationships in cardiovascular operations: New York state, 1990-1995

Sollano, Josephine A.; Gelijns, Annetine C.; Moskowitz, Alan J.; Heitjan, Daniel F.; Cullinane, Suzanne; Saha, Ted; Chen, Jonathan M.; Roohan, Patrick J.; Reemtsma, K; Shields, Eileen

doi:10.1016/s0022-5223(99)70320-x

Cited by 127 publications

(75 citation statements)

References 13 publications

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“…This finding supports and extends the results from Peterson et al (2004), Halm et al (2002, Luft et al (1987) and Sollano et al (1999) who have previously found that volume improves outcome. In addition to the effect of hospital volume on the outcomes for all cardiac patients, we make two more findings for the effect of volume on outcome.…”

Section: Aggregate Effects Of Focussupporting

confidence: 92%

The Effects of Focus on Performance: Evidence from California Hospitals

2011

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We use hospital-level discharge data from cardiac patients in California to estimate the effects of focus on operational performance. We examine focus at three distinct levels of the organization-at the firm level, at the operating unit level, and at the process flow level. We find that focus at each of these levels is associated with improved outcomes, namely, faster services at higher levels of quality, as indicated by lower lengths of stay (LOS) and reduced mortality rates. We then analyze the extent to which the superior operational outcome is driven by focused hospitals truly excelling in their operations or by focused hospitals simply "cherry-picking" easy-to-treat patients. To do this, we use an instrumental variables estimation strategy that effectively randomizes the assignment of patients to hospitals. After controlling for selective patient admissions, the previously observed benefits of firm level focus disappear; focused hospitals no longer demonstrate a statistically significant reduction in LOS or mortality rate. However, at more granular measures of focus within the hospital (e.g., operating unit level), we find that more focus leads to a shorter LOS, even after controlling for selective admission effects. We use hospital level discharge data from cardiac patients in California to estimate the effects of focus on operational performance. We examine focus at three distinct levels of the organization -at the firm level, at the operating unit level, and at the process flow level. We find that focus at each of these levels is associated with improved outcomes, namely faster services at higher levels of quality, as indicated by lower lengths of stay (LOS) and reduced mortality rates. We then analyze the extent to which the superior operational outcome is driven by focused hospitals truly excelling in their operations or by focused hospitals simply "cherry-picking" easy-to-treat patients. To do this, we use an instrumental variables estimation strategy that effectively randomizes the assignment of patients to hospitals. After controlling for selective patient admissions, the previously observed benefits of firm-level focus disappear; focused hospitals no longer demonstrate a statistically significant reduction in LOS or mortality rate. However, at more granular measures of focus within the hospital (e.g. operating unit level), we find that more focus leads to a shorter LOS, even after controlling for selective admission effects.

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Section: Aggregate Effects Of Focussupporting

confidence: 92%

The Effects of Focus on Performance: Evidence from California Hospitals

2011

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“…Our study, when put into context with others that suggest decreased morbidity in specialist centres, [4][5][6] makes the case for specialisation appear compelling.…”

Section: Resultssupporting

confidence: 59%

“…3 Recent suggestions have been made of associations between high patient volume and a decreased morbidity thus backing claims for specialist centres. [4][5][6] Developmental dysplasia of the hip is a specialist condition and its surgical treatment usually only occurs at tertiary centres. The development of avascular necrosis after the treatment of a developmental dysplasia of the hip is iatrogenic.…”

mentioning

confidence: 99%

Learning Curves in Orthopaedic Surgery: A Case for Super-Specialisation?

Jain

Jowett

Clarke

2007

annals

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“…All follow the Canadian Best Practice Recommendations for Stroke Care. 17 During the past few decades, there has been growing evidence that links increased patient volumes to improved outcomes in relation to complex medical and surgical procedures, including heart transplantation, 18 -25 but also increasingly for subspecialty clinics like anticoagulation clinics 24 and heart failure clinics. 25 However, the mechanisms by which these clinics result in improved outcomes remain elusive.…”

Section: Discussionmentioning

confidence: 99%

Organized Outpatient Care

Webster

Saposnik

Kapral

et al. 2011

Stroke

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Background and Purpose-Organized inpatient stroke care decreases mortality and morbidity irrespective of patient age, stroke severity, or stroke subtype. Limited information is available on whether organized outpatient care models such as stroke prevention clinics (SPC) improve outcomes after a transient ischemic attack or ischemic stroke. We compared 1-year mortality and stroke readmission in patients with transient ischemic attack or ischemic stroke referred versus not referred to an SPC. Methods-This was a retrospective cohort study including 16 468 consecutive patients with ischemic stroke or transient ischemic attack who were seen in the emergency department or admitted to a hospital between July 1, 2003 and March 31, 2008 at registry stroke centers (nϭ12) in the province of Ontario. Cox proportional hazards models and propensity score-matched analyses were used to evaluate 1-year mortality and readmission. Results-One-year mortality rates were lower in those referred to SPCs compared with those not referred, even after adjustment for age, sex, ethnic origin, income, comorbid conditions, stroke symptoms and severity, receipt of thrombolysis, stroke unit care, discharge destination, and functional status at discharge (adjusted hazard ratio [HR], 0.67; 95% CI, 0.60 -0.75). Survival analysis after propensity matching showed a 26% reduction in 1-year mortality (HR, 0.74; 95% CI, 0.65-0.84). There were no significant differences in 1-year readmission rates in those referred versus not referred to SPCs. Conclusions-Referral to an SPC is associated with a one-quarter reduction in mortality after ischemic stroke or transient ischemic attack. This supports the argument that outpatient stroke units may prove as effective as their inpatient counterparts. (Stroke. 2011;42:3176-3182.)

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Volume-outcome relationships in cardiovascular operations: New York state, 1990-1995

Cited by 127 publications

References 13 publications

The Effects of Focus on Performance: Evidence from California Hospitals

The Effects of Focus on Performance: Evidence from California Hospitals

Learning Curves in Orthopaedic Surgery: A Case for Super-Specialisation?

Organized Outpatient Care

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