Black N, Johnston A
London School of Hygiene and Tropical Medicine.
Health Serv Manage Res. 1990 Jul;3(2):108-14. doi: 10.1177/095148489000300205.
The relationship between the volume of work undertaken in a hospital and the outcome of care has assumed increasing importance in recent years. A review of the literature reveals that most studies have been carried out in the USA and have largely been confined to six specific areas of health care. There is evidence that better outcomes are obtained at higher volumes for several surgical operations, cardiac catheterisation and care of the severely injured. As yet there is no clear association for coronary, neo-natal and burn care. There are two competing hypotheses to explain any association -- 'practice-makes-perfect' and 'selective referral'. These are discussed and implications for the future provision of hospital services considered.
近年来，医院的工作量与护理结果之间的关系变得越来越重要。对文献的回顾显示，大多数研究是在美国进行的，并且主要局限于六个特定的医疗保健领域。有证据表明，在一些外科手术、心脏导管插入术和重伤护理方面，工作量越大，结果越好。然而，对于冠心病、新生儿护理和烧伤护理，目前尚无明确的关联。有两种相互竞争的假说来解释这种关联——“熟能生巧”和“选择性转诊”。本文将对这两种假说进行讨论，并探讨其对未来医院服务提供的影响。
