Why do high-volume hospitals achieve better outcomes? A systematic review about intermediate factors in volume–outcome relationships

Mesman, Roos; Westert, Gert P.; Berden, Bart J.M.M.; Faber, Marjan J.

doi:10.1016/j.healthpol.2015.04.005

Cited by 84 publications

(78 citation statements)

References 47 publications

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“…Similarly, because the number of A-CRA treatment procedures delivered has been shown to be an important predictor of client outcomes (Garner et al, 2009), we hypothesized organizations providing a greater number of A-CRA procedures on average (i.e., procedure exposure) would also have greater improvements in their A-CRA client’s outcomes. Because the absolute volume of patients has been shown to be associated with better organizational outcomes (Mesman, Westert, Berden, & Faber, 2015), we hypothesized organizations that provided A-CRA to more clients (i.e., client penetration) would also have greater improvements in their A-CRA client’s outcomes. Finally, because absolute cumulative team experience has been shown to be important (Elbardissi, Duclos, Rawn, Orgill, & Carty, 2013), we hypothesized organizations with a greater cumulative A-CRA experience (i.e., staff penetration) would also have greater improvements in their A-CRA client’s outcomes.…”

Section: Introductionmentioning

confidence: 99%

Toward Evidence-Based Measures of Implementation: Examining the Relationship Between Implementation Outcomes and Client Outcomes

Garner

Hunter

Funk

et al. 2016

Journal of Substance Abuse Treatment

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Background Developing consistent, valid, and efficient implementation outcome measures is necessary to advance implementation science. However, development of such measures has been limited to date, especially for validating the extent to which such measures are associated with important improvements in client outcomes. This study seeks to address this gap by developing one or more evidence-based measures of implementation (EBMIs; i.e., implementation outcome measure that is predictive of improvements in key client outcomes) for the Adolescent Community Reinforcement Approach (A-CRA), an evidence-based practice (EBP) for adolescent substance use. Methods Data for the current study were collected as part of a large-scale federally funded EBP dissemination and implementation initiative. The multilevel dataset included 65 substance use treatment organizations, 308 clinicians, and 5,873 adolescent clients. Adjusted multilevel regression analyses were used to examine the extent to which client-level outcome measures assessed at 6-month follow-up (i.e., substance use, emotional problems) could be predicted by four implementation outcomes: two measures of fidelity (i.e., session exposure, procedure exposure) and two measures of penetration (i.e., absolute client penetration, absolute staff penetration). Results Adjusting for client substance use at intake, as well as several client characteristics (e.g., age, race, criminal justice involvement), client substance use at follow-up was significantly lower for treatment organizations that had higher procedure exposure (B=−1.227, standard error [SE]=0.583, 95% confidence interval=−2.370, 0.252; p<.05). None of the other three implementation outcome measures were found to predict improvements in client outcomes. Conclusions The current study provides support for procedure exposure as an organizational-level EBMI for A-CRA. Thus, future efforts focused on implementing A-CRA could be improved by measuring and monitoring the extent to which A-CRA procedures are being delivered to clients. Additionally, given the dearth of studies that have examined the relationship between organizational-level measures of implementation and client outcomes, this article provides a prototype for future research to identify EBMIs for other behavioral treatments.

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Section: Introductionmentioning

confidence: 99%

Toward Evidence-Based Measures of Implementation: Examining the Relationship Between Implementation Outcomes and Client Outcomes

Garner

Hunter

Funk

et al. 2016

Journal of Substance Abuse Treatment

View full text Add to dashboard Cite

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“…Research into quality improvement in surgery has focused on the effect of surgeon and hospital volume on outcomes 15,16 . Spillane et al 6,8 demonstrated a higher lnrr for surgeons at the high-volume Sydney Melanoma Unit than for other Australian surgeons.…”

Section: Discussionmentioning

confidence: 99%

Lymph Node Retrieval Rates in Melanoma: A Quality Assessment Parameter

et al. 2017

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“…explain part of the observed VOR (Mesman, Westert, Berden, & Faber, 2015). They identified three categories of intermediate factors: compliance with an evidence-based process of care, the level of specialization, and hospital-related factors (e.g., capacity, staffing, health services, etc.…”

Section: Intermediate Factors That Couldmentioning

confidence: 99%

What Underlies the Observed Hospital Volume-Outcome Relationship?

et al. 2018

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Abstract:Studies of the hospital volume-outcome relationship have highlighted that a greater volume activity improves patient outcomes. While this finding has been known for years in health services research, most studies to date have failed to delve into what underlies this relationship. This study aimed to shed light on the basis of the hospital volume effect by comparing treatment modalities for epithelial ovarian carcinoma patients. Hospital volume activity was instrumented by the distance from patients' homes to their hospital, the population density, and the median net income of patient municipalities. We found that higher volume hospitals appear to more often make the right decisions in regard to how to treat patients, which contributes to the positive impact of hospital volume activities on patient outcomes. Based on our parameter estimates, we found that the rate of complete tumor resection would increase by 10% with centralized care, and by 6% if treatment decisions were coordinated by high volume centers compared to the ongoing organization of care. In both scenarios, the use of neoadjuvant chemotherapy would increase by 10%. As volume alone is an imperfect correlate of quality, policy makers need to know what volume is a proxy for in order to devise volume-based policies. Keywords:Volume outcome relationship, France, Epithelial Ovarian Cancer, Instrumental variable, Organization of care, Care pathway, Learning effect, Centralization of care. for epithelial ovarian carcinoma patients. Hospital volume activity was instrumented by the distance from patients' homes to their hospital, the population density, and the median net income of patient municipalities. We found that higher volume hospitals appear to more often make the right decisions in regard to how to treat patients, which contributes to the positive impact of hospital volume activities on patient outcomes. Based on our parameter estimates, we found that the rate of complete tumor resection would increase by 10% with centralized care, and by 6% if treatment decisions were coordinated by high volume centers compared to the ongoing organization of care. In both scenarios, the use of neoadjuvant chemotherapy would increase by 10%. As volume alone is an imperfect correlate of quality, policy makers need to know what volume is a proxy for in order to devise volume-based policies.

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Why do high-volume hospitals achieve better outcomes? A systematic review about intermediate factors in volume–outcome relationships

Cited by 84 publications

References 47 publications

Toward Evidence-Based Measures of Implementation: Examining the Relationship Between Implementation Outcomes and Client Outcomes

Toward Evidence-Based Measures of Implementation: Examining the Relationship Between Implementation Outcomes and Client Outcomes

Lymph Node Retrieval Rates in Melanoma: A Quality Assessment Parameter

What Underlies the Observed Hospital Volume-Outcome Relationship?

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