Finlayson Samuel R G
Department of Surgery, Dartmouth Medical School, Hanover, New Hampshire, USA.
Am Surg. 2006 Nov;72(11):1038-42; discussion 1061-9, 1133-48.
Multiple studies support the intuitive association between higher provider procedure volume and better clinical outcomes. Health care purchasers and payers have been seeking ways to direct patients to high-volume providers to improve the quality of care received and to avoid costs associated with higher surgical morbidity. Volume-based referral has faced resistance from providers who are concerned that the use of volume instead of more direct measures of surgical quality will result in unfair discrimination. On close examination, volume-based referral policies also appear to be more congruent with payers' interests than the interests of individual patients and providers. Furthermore, a policy of volume-based referral does not address surgical quality directly, is applicable to only a very small segment of surgical care, and is logistically problematic. However, in the absence of viable alternative measures of surgical quality, imperfect proxies such as volume will likely continue to be a significant part of the national dialogue surrounding surgical quality.
多项研究支持了医疗服务提供者手术量越高与临床结果越好之间的直观关联。医疗保健购买者和支付方一直在寻求方法，引导患者前往手术量高的医疗服务提供者处，以提高所接受护理的质量，并避免与手术并发症增加相关的成本。基于手术量的转诊受到了医疗服务提供者的抵制，他们担心使用手术量而非更直接的手术质量衡量标准会导致不公平的歧视。仔细审视后发现，基于手术量的转诊政策似乎也更符合支付方的利益，而非个体患者和医疗服务提供者的利益。此外，基于手术量的转诊政策并未直接解决手术质量问题，仅适用于非常小一部分的手术护理，且在后勤方面存在问题。然而，在缺乏可行的手术质量替代衡量标准的情况下，诸如手术量这样的不完美替代指标可能仍将是围绕手术质量的全国性讨论的重要组成部分。
