Sowden A J, Sheldon T A
University of York, UK.
J Health Serv Res Policy. 1998 Jul;3(3):187-90. doi: 10.1177/135581969800300311.
There is a prevailing consensus that the quality of health services can be improved by concentrating care in the hands of those providers who carry out larger volumes of activity. The substantial research literature indicates a positive volume-quality relationship. However, these conclusions are largely based on observational studies using administrative databases which are poorly adjusted for case mix. Better control for confounding shows that volume-quality effects in several cases may be an artefact. The research is also difficult to interpret because of the limited measurement of outcomes, poor analysis of the relative contributions of the clinician and the hospital levels, and the lack of clarity about the direction of cause and effect. Most research is insufficiently reliable to inform policy on the use of volume for credentialling or for the re-configuration of services.
有一种普遍的共识，即通过将护理集中在那些开展大量医疗活动的提供者手中，可以提高卫生服务的质量。大量的研究文献表明存在积极的量-质关系。然而，这些结论主要基于使用行政数据库的观察性研究，而这些数据库对病例组合的调整很差。对混杂因素进行更好的控制表明，在某些情况下量-质效应可能是一种假象。由于结局测量有限、对临床医生和医院层面的相对贡献分析不足以及因果关系方向不明确，该研究也难以解释。大多数研究的可靠性不足，无法为关于将医疗量用于资格认证或服务重新配置的政策提供依据。
