Roeder N, Wenke A, Heumann M, Franz D
DRG-Research-Group, Universitätsklinikum Münster, Domagkstrasse 25, Münster, Germany.
Chirurg. 2007 Nov;78(11):1018-27. doi: 10.1007/s00104-007-1414-5.
Consequences of the volume outcome relationship are controversial. Objectification based on data analysis is strongly needed. The aim of this publication was to analyse the effects of volume outcome reallocations based on German inpatient data.
The analysis based on inpatient data of the Krankenhauszweckverband Koeln, Bonn und Region (Hospital Association of the Cologne and Bonn Region) of 2002 and 2005. Relevant data sets were identified according to the effects of current German regulations on volume outcome on the special fields liver transplant, kidney transplant, complex pancreatic surgery, and complex oesophageal surgery.
The effects of current German regulations on volume outcome results differed greatly between the four surgical specialities. There were fewer effects on kidney transplant, but due to an already very high level of centralisation 34% (oesophagus) and 8% (pancreas) of the hospitals stopped related surgery. This affected 8.9% (oesophagus) and 2.2% (pancreas) of related cases.
Concentration and the formation of specialised medical centres are results of the implementation of volume outcome relationships. The quality of medical treatment does not automatically improve from this development. It is necessary to analyse any correlation between quality and frequency of treatment or other criteria such as know-how, structure and process management, and multidisciplinarity.
手术量与治疗结果之间的关系所产生的影响存在争议。基于数据分析的客观化分析十分必要。本出版物的目的是根据德国住院患者数据，分析手术量结果重新分配的影响。
基于科隆、波恩及周边地区医院协会2002年和2005年的住院患者数据进行分析。根据德国现行法规对肝脏移植、肾脏移植、复杂胰腺手术和复杂食管手术等特殊领域的手术量结果的影响，确定相关数据集。
德国现行法规对手术量结果的影响在这四个外科专业之间差异很大。对肾脏移植的影响较小，但由于已经处于非常高的集中化水平，34%（食管）和8%（胰腺）的医院停止了相关手术。这影响了8.9%（食管）和2.2%（胰腺）的相关病例。
医疗中心的集中化和专业化形成是手术量与治疗结果关系实施的结果。这种发展并不会自动提高医疗质量。有必要分析治疗质量与治疗频率之间的任何相关性，或其他标准，如专业知识、结构和流程管理以及多学科性。
