Abstract
PURPOSE: The effects of regionalization of tertiary care were studied by analyzing cost and outcome for pancreaticoduodenectomies in a state in which the majority of these high-risk procedures were performed in one hospital. METHODS: Using Maryland inpatient discharge data via a retrospective study, the authors compared cost and outcome data for a hospital with more than one half of the cases in the state to all other hospital providers as a group and with smaller groupings according to the volume of procedures performed. RESULTS: Hospital mortality, length of stay, and costs were significantly less at the high-volume regional medical center when compared with all other hospitals. Mortality and cost increased as volume decreased when hospitals were grouped according to volume. CONCLUSIONS: An academic medical center, functioning as a high-volume regional provider, can deliver tertiary care services with improved outcomes at lower costs than community hospitals.
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- Droste T. 'Center of excellence' name tag carries clout. Hospitals. 1989 Jan 20;63(2):54–54. [PubMed] [Google Scholar]
- Flood A. B., Scott W. R., Ewy W. Does practice make perfect? Part I: The relation between hospital volume and outcomes for selected diagnostic categories. Med Care. 1984 Feb;22(2):98–114. [PubMed] [Google Scholar]
- Flood A. B., Scott W. R., Ewy W. Does practice make perfect? Part II: The relation between volume and outcomes and other hospital characteristics. Med Care. 1984 Feb;22(2):115–125. [PubMed] [Google Scholar]
- Hannan E. L., Kilburn H., Jr, O'Donnell J. F., Bernard H. R., Shields E. P., Lindsey M. L., Yazici A. A longitudinal analysis of the relationship between in-hospital mortality in New York State and the volume of abdominal aortic aneurysm surgeries performed. Health Serv Res. 1992 Oct;27(4):517–542. [PMC free article] [PubMed] [Google Scholar]
- Hannan E. L., O'Donnell J. F., Kilburn H., Jr, Bernard H. R., Yazici A. Investigation of the relationship between volume and mortality for surgical procedures performed in New York State hospitals. JAMA. 1989 Jul 28;262(4):503–510. [PubMed] [Google Scholar]
- Hughes R. G., Hunt S. S., Luft H. S. Effects of surgeon volume and hospital volume on quality of care in hospitals. Med Care. 1987 Jun;25(6):489–503. doi: 10.1097/00005650-198706000-00004. [DOI] [PubMed] [Google Scholar]
- Jencks S. F., Williams D. K., Kay T. L. Assessing hospital-associated deaths from discharge data. The role of length of stay and comorbidities. JAMA. 1988 Oct 21;260(15):2240–2246. [PubMed] [Google Scholar]
- Luft H. S., Bunker J. P., Enthoven A. C. Should operations be regionalized? The empirical relation between surgical volume and mortality. N Engl J Med. 1979 Dec 20;301(25):1364–1369. doi: 10.1056/NEJM197912203012503. [DOI] [PubMed] [Google Scholar]
- Luft H. S., Hunt S. S. Evaluating individual hospital quality through outcome statistics. JAMA. 1986 May 23;255(20):2780–2784. [PubMed] [Google Scholar]
- Luft H. S. The relation between surgical volume and mortality: an exploration of causal factors and alternative models. Med Care. 1980 Sep;18(9):940–959. doi: 10.1097/00005650-198009000-00006. [DOI] [PubMed] [Google Scholar]
- Maerki S. C., Luft H. S., Hunt S. S. Selecting categories of patients for regionalization. Implications of the relationship between volume and outcome. Med Care. 1986 Feb;24(2):148–158. doi: 10.1097/00005650-198602000-00006. [DOI] [PubMed] [Google Scholar]
- Renlund D. G., Bristow M. R., Lybbert M. R., O'Connell J. B., Gay W. A., Jr Medicare-designated centers for cardiac transplantation. N Engl J Med. 1987 Apr 2;316(14):873–876. doi: 10.1056/NEJM198704023161411. [DOI] [PubMed] [Google Scholar]
- Traska M. R. In search of centers of excellence. Bus Health. 1989 Sep;7(9):11-4, 16. [PubMed] [Google Scholar]
- Wallace C. Centers for excellence. Mod Healthc. 1988 May 20;18(21):30–32. [PubMed] [Google Scholar]