Advertisement

Volume, Quality, and Research of the Modern Hospital: The Survivable Strategy

  • Xiang Da (Eric) DongEmail author
  • Rifat Latifi

Abstract

The volume of a disease treated by a hospital and the quality of care delivered by a hospital have a known proportionate relationship. In the design of a new hospital, or the addition of new clinical services to an existing hospital, one of the central tenets is the ability to provide high-quality care that hopefully is combined with excellent outcomes. There are certain high-risk procedures known to require high-volume multimodality care to produce quality outcomes. Best examples of quality healthcare that are related to volume are high-risk surgical cases such as coronary artery bypass grafting, abdominal aortic aneurysm repair, liver transplantation, esophagectomy, pancreatectomy, and other high-risk oncologic procedures. As a result, when creating or advancing new clinical programs, the need to research the regional patient population and to concentrate on the regional patient needs is crucial to the success of the new hospital. The ability to understand the critical clinical and organizational differences between low- and high-volume hospitals may help implement changes to improve care. Therefore, in this rapidly evolving environment with introduction of new medical and surgical technologies, implementation of electronic medical records, adherence to regulatory measures such as the Joint Commission and the Hospital Quality Alliance public reporting, changing needs of the resident patient population, the building of new clinical programs capable of adapting to the changing environment may be the best solution.

Keywords

Patient volume Quality of care Research Multimodality approach Rural hospitals Patient-centered care High-volume procedures 

References

  1. 1.
  2. 2.
    Milstein A, Galvn RS, Delbanco SF, Salber P, Buck CR. Improving the safety of health care: the leapfrog initiative. Eff Clin Pract. 2000;6:313–6.Google Scholar
  3. 3.
    Dong GN. Performing well in financial management and quality of care: evidence from hospital process management for treatment of cardiovascular disease. BMC Health Serv Res. 2015;15:45.  https://doi.org/10.1186/s12913-015-0690-x.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Jha AK, Li Z, Orav J, Epstein AM. Care in U.S. hospitals – the hospital quality alliance program. NEJM. 2005;353:265–74.  https://doi.org/10.1056/NEJMsa051249.CrossRefPubMedGoogle Scholar
  5. 5.
    Harkey J, Vraciu R. Quality of health care and financial performance: is there a link? Health Care Manag Rev. 1992;17:55–63. PMID: 1428860.Google Scholar
  6. 6.
    Bai G, Anderson GF. A more detailed understanding of factors associated with hospital profitability. Health Aff. 2016;35:5.  https://doi.org/10.1377/hlthaff.2015.1193.CrossRefGoogle Scholar
  7. 7.
    Horwitz JR. Making profits and providing care: comparing nonprofit, for-profit, and government hospitals. Health Aff. 2005;24:3.  https://doi.org/10.1377/hlthaff.24.3.790.CrossRefGoogle Scholar
  8. 8.
    Hall MF. Looking to improve financial results? Start by listening to patients: improving patient satisfaction can have a direct impact on your hospitals reputation--and financial results. Healthc Financ Manage. 2008:76+. Academic OneFile, Accessed 17 Apr 2018.Google Scholar
  9. 9.
    Jha AK, Orav EJ, Zheng J, Epstein AM. Patients’ perception of hospital care in United States. N Engl J Med. 2008;359:1921–31.  https://doi.org/10.1056/NEJMsa0804116.CrossRefPubMedGoogle Scholar
  10. 10.
    Hughes RG, Hunt SS, Luft HS. Effects of surgeon volume and hospital volume on quality of care in hospitals. Med Care. 1987;25:489–503.CrossRefGoogle Scholar
  11. 11.
    Luft HS, Bunker JP, Enthoven AC. Should operations be regionalized? The empirical relation between surgical volume and mortality. N Engl J Med. 1979;301:1364–9.CrossRefGoogle Scholar
  12. 12.
    Begg CB, Cramer LD, Hoskins WJ, Brennan MF. Impact of hospital volume on operative mortality for major cancer surgery. JAMA. 1998;280:1747–51.CrossRefGoogle Scholar
  13. 13.
    Halm EA, Lee C, Chassin MR. Is volume related to outcome in health care? A systematic review and methodologic critique of the literature. Ann Intern Med. 2002;137:511–20.  https://doi.org/10.7326/0003-4819-137-6-200209170-00012.CrossRefPubMedGoogle Scholar
  14. 14.
    Hannan EL, Kilburn H Jr, O’Donnell JF, Lukacik G, Shields EP. Adult open heart surgery in New York state: an analysis of risk factors and hospital mortality rates. JAMA. 1990;264:2768–74.CrossRefGoogle Scholar
  15. 15.
    Dranove D, Stekas A. Start spreading the news: a structural estimate of the effects of New York hospital report cards. J Health Econ. 2008;27:1201–7.  https://doi.org/10.1016/j.healeco.2008.03.001.CrossRefPubMedGoogle Scholar
  16. 16.
    Birkmeyer JD. Should we regionalize major surgery? Potential benefits and policy considerations. J Am Coll Surg. 2000;190:341–9.CrossRefGoogle Scholar
  17. 17.
    Birkmeyer JD. High risk surgery – follow the crowd. JAMA. 2000;283:1191–3.CrossRefGoogle Scholar
  18. 18.
    Dudley RA, Johansen KL, Brand R, Rennie DJ, Milstein A. Selective referral to high-volume hospitals: estimating potentially avoidable deaths. JAMA. 2000;283:1159–66.CrossRefGoogle Scholar
  19. 19.
    Harlan BJ. Presidential address: statewide reporting of coronary artery surgery results: a view from California. J Thorac Cardiovasc Surg. 2001;121:409–16.CrossRefGoogle Scholar
  20. 20.
    Birkmeyer JD, Siewers AE, Finlayson EVA, Stukel TA, Lucas FL, Batista I, Welch G, Wennberg DE. Hospital volume and surgical mortality in the Unites States. N Engl J Med. 2002;346:1128–37.  https://doi.org/10.1056/NEJMsa012337.CrossRefPubMedGoogle Scholar
  21. 21.
    Zinman D. Ranking open-heart surgery: state study lists best hospitals. New York Newsday. 1990 Dec 4; Sec. A:4.Google Scholar
  22. 22.
    Hannan EL, Kumar D, Racz M, Siu AL, Chassin MR. New York State’s cardiac surgery reporting system: four years later. Ann Thorac Surg. 1994;58:1852–7.CrossRefGoogle Scholar
  23. 23.
    Finlayson EVA, Goodney PP, Birkmeyer JD. Hospital volume and operative mortality in cancer surgery. Arch Surg. 2003;138:721–5.CrossRefGoogle Scholar
  24. 24.
    LaPar DJ, Kron IL, Jones DR, Stukenborg GJ, Kozower BD. Hospital procedure volume should not be used as a measure of surgical quality. Ann Surg. 2012;256:606–15.  https://doi.org/10.1097/SLA.0b012e31826b4be6.CrossRefPubMedGoogle Scholar
  25. 25.
    Reames BN, Ghaferi AA, Birkmeyer JD, Dimick JB. Hospital volume and operative mortality in the modern era. Ann Surg. 2014;260:244–51.  https://doi.org/10.1097/SLA.0000000000000375.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Daley J. Invited commentary: quality of care and the volume-outcome relationship – what’s next for surgery? Surgery. 2002;131:16–8.CrossRefGoogle Scholar
  27. 27.
    Gordon TA, Bowman HM, Tielsch JM, Bass EB, Burleyson GP, Cameron JL. Statewide regionalization of pancreaticoduodenectomy and its effect on in-hospital mortality. Ann Surg. 1998;228:71–8.CrossRefGoogle Scholar
  28. 28.
    Birkmeyer JD, Finlayson EVA, Birkmeyer CM. Volume standards for high-risk surgical procedures: potential benefits of the Leapfrog initiative. Surgery. 2001;130:415–22.  https://doi.org/10.1067/msy.2001.117139.CrossRefPubMedGoogle Scholar
  29. 29.
    Christian CK, Gustafson ML, Betensky RA, Daley J, Zinner MJ. The Leapfrog volume criteria may fall short in identifying high-quality surgical centers. Ann Surg. 2003;238:447–57.  https://doi.org/10.1097/01.sla.0000089850.27592.eb.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Boudourakis L, Wang T, Roman S, Desai R, Sosa J. Evolution of the surgeon-volume, patient-outcome relationship. Ann Surg. 2009;250:159–65.  https://doi.org/10.1097/SLA.0b013e318a77cb3.CrossRefPubMedGoogle Scholar
  31. 31.
    Bruce H, Hamilton B, Richards K, Bilimoria K, Cohen M, Ko C. Does surgical quality improve in the American College of Surgeons National Surgical Quality Improvement Program: an evaluation of all participating hospitals. Ann Surg. 2009;250(3):363–76.  https://doi.org/10.1097/SLA.0b013e3181b4148f.CrossRefGoogle Scholar
  32. 32.
    Epstein AM. Volume and outcome – it is time to move ahead. N Engl J Med. 2002;346:1161–4.CrossRefGoogle Scholar
  33. 33.
    Moscovice IS. Rural hospitals: a literature synthesis and health services research agenda. Health Serv Res. 1989;23:892–930.Google Scholar
  34. 34.
    Joynt KE, Harris Y, Orav EJ, Jha AK. Quality of care and patient outcome in critical access rural hospitals. JAMA. 2011;306:45–52.PubMedPubMedCentralGoogle Scholar
  35. 35.
    Casey MM, Davidson G. Upper Midwest rural health research center final report #10: patient assessments and quality of care in rural hospitals. Minneapolis: Upper Midwest Rural Health Research Center, University of Minnesota; 2010.Google Scholar
  36. 36.
    Keeler EB, Rubenstein LV, Kahn KL. Hospital characteristics and quality of care. JAMA. 1992;268:1709–14.  https://doi.org/10.1001/jama.1992.03490130097037.CrossRefPubMedGoogle Scholar
  37. 37.
    Studnicki J, Craver C, Blanchette CM, Fisher JW, Shahbazi S. A cross-sectional retrospective analysis of the regionalization of complex surgery. BMC Surg. 2014;14:55.  https://doi.org/10.1186/1471-2482-14-55.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Finks JF, Osborne NH, Birkmeyer J. Trend in hospital volume and operative mortality for high-risk surgery. NEJM. 2011;364:2128–37.  https://doi.org/10.1056/NEJMsa1010705.CrossRefPubMedGoogle Scholar
  39. 39.
    Birkmeyer JD, Dimick JB. Potential benefits of the new Leapfrog standards: effect of process and outcomes measures. Surgery. 2004;135:568–75.  https://doi.org/10.1016/j.surg.2004.03.004.CrossRefGoogle Scholar
  40. 40.
    Galvin RS, Delbanco S, Milstein A, Belden G. Has the Leapfrog group had an impact on the health care market. Health Aff. 2005;24:1.  https://doi.org/10.1377/hlthaff.24.1.228.CrossRefGoogle Scholar
  41. 41.
    Brooke BS, Perler BA, Dominici F, Makary MA, Pronovost PJ. Reduction of in-hospital mortality among California hospitals meeting Leapfrog evidence-based standards for abdominal aortic aneurysm repair. J Vasc Surg. 2008;47:1155–64.CrossRefGoogle Scholar
  42. 42.
    Lindenauer PK, Remus D, Roman S, Rothberg M, Benjamin EM, Bratzler DW. Public reporting and pay for performance in hospital quality improvement. NEJM. 2007;356:486–96.  https://doi.org/10.1056/NEJMsa064964.CrossRefPubMedGoogle Scholar
  43. 43.
    Kolstad JT, Chernew ME. Quality and consumer decision making in the market for health insurance and health care services. Med Care Res Rev. 2009;66:28S–52S.CrossRefGoogle Scholar
  44. 44.
    Hibbard JH, Peters E. Supporting informed consumer health care decisions: data presentation approaches that facilitate the use of information in choice. Annu Rev Public Health. 2003;24:413–33.  https://doi.org/10.1146/annurev.publhealth.24.100901.141005. Epub 2001, Nov 6. PMID: 12428034.CrossRefPubMedGoogle Scholar
  45. 45.
    Hibbard JH, Jewett JJ, Engelmann S, Tusler M. Can Medicare beneficiaries make informed choices? Health Aff. 1998;17:181–93.CrossRefGoogle Scholar
  46. 46.
    Tunis SR, Messner DA. Medicare policy on bariatric surgery: decision making in the face of uncertainty. JAMA. 2013;310(13):1339–40.  https://doi.org/10.1001/jama.2013.278849.CrossRefPubMedGoogle Scholar
  47. 47.
    Allison A. The community hospital survival guide: strategies to keep the doors open. Becker Hospital CFO report. 2015.Google Scholar
  48. 48.
    Anderson GF. From ‘soak the rich’ to ‘soak the poor’: recent trends in hospital pricing. Health Aff. 2007;26:3.  https://doi.org/10.1377/hlthaff.26.3.780.CrossRefGoogle Scholar
  49. 49.
    AHA 2016 annual survey. AHA Hospital Statistics, 2018 edition. https://www.aha.org/statistics/fast-facts-us-hospitals
  50. 50.
    Kaysen R. To survive, medical companies in New Jersey are building new hospitals. The New York Times. 2011.Google Scholar
  51. 51.
    Ho V, Town RJ, Heslin MJ. Regionalization versus competition in complex cancer surgery. Health Econ Policy Law. 2007;2:51–71.CrossRefGoogle Scholar
  52. 52.
    Aggarwal A, Lewis D, Mason M, Purushotham A, Sullivan R, van der Meulen J. Effect of patient choice and hospital competition on service configuration and technology adoption within cancer surgery: a national, population-based study. Lancet Oncol. 18:1453–45.CrossRefGoogle Scholar
  53. 53.
    Nguyen PL, Gu X, Lipsitz SR. Cost implications of the rapid adoption of newer technologies for treating prostate cancer. J Clin Oncol. 2011;29:1517–24. [PubMed: 21402604].CrossRefGoogle Scholar
  54. 54.
    Frencher SK, Ryoo JJ, Ko CL. Emerging importance of certification: volume, outcomes, and regionalization of care. J Surg Oncol. 2009;99:131–2.CrossRefGoogle Scholar
  55. 55.
    Urbach DR, Baxter NN. Does it matter what a hospital is “high volume” for? Specificity of hospital volume-outcome associations for surgical procedures: analysis of administrative data. Qual Saf Health Care. 2004;13:379–83.  https://doi.org/10.1136/bmj.38030.642963.AE.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.New York Medical College, School of Medicine, Department of Surgery, Surgical Oncology, Westchester, Medical CenterValhallaUSA
  2. 2.New York Medical College, School of Medicine, Department of Surgery and Westchester Medical CenterValhallaUSA

Personalised recommendations