Ho Vivian
Department of Health Care Organization and Policy, University of Alabama Birmingham, 35294-0022, USA.
J Health Econ. 2002 Sep;21(5):873-85. doi: 10.1016/s0167-6296(02)00057-7.
This study uses longitudinal data on patients receiving percutaneous transluminal coronary angioplasty (PTCA) to examine changes in outcomes and costs. All hospitals achieved substantial reductions in inpatient mortality and emergency bypass surgery over time, regardless of the number of procedures performed. Annual hospital procedure volume was also associated with improved outcomes, although the effect is small. There was no evidence that learning by doing (cumulative PTCA volume) influenced outcomes. The high correlation between annual and cumulative procedure volume precludes a point estimate of the effect of learning by doing on costs, although the upper bound on the potential learning effect is sizeable. The results suggest that centralizing provision of PTCA may lead to lower costs, but only small outcomes improvements.
本研究使用接受经皮冠状动脉腔内血管成形术（PTCA）患者的纵向数据来检验结果和成本的变化。随着时间的推移，所有医院的住院死亡率和急诊搭桥手术均大幅降低，无论所实施手术的数量如何。年度医院手术量也与更好的结果相关，尽管效果较小。没有证据表明实践学习（累积PTCA量）会影响结果。年度手术量与累积手术量之间的高度相关性使得无法对实践学习对成本的影响进行点估计，尽管潜在学习效应的上限相当可观。结果表明，集中提供PTCA可能会降低成本，但结果改善幅度较小。
