Luft H S, Hunt S S, Maerki S C
Health Serv Res. 1987 Jun;22(2):157-82.
Various studies have demonstrated that hospitals with larger numbers of patients with a specific diagnosis or procedure have lower mortality rates. In some instances, these results have been interpreted to mean that physicians and hospital personnel with more of these patients develop greater skills and that this results in better outcomes--the "practice-makes-perfect" hypothesis. An alternative explanation is that physicians and hospitals with better outcomes attract more patients--the "selective-referral pattern" hypothesis. Using data for 17 categories of patients from a sample of over 900 hospitals, we examine the patterns of selected variables with respect to hospital volume. To explore the plausibility of each hypothesis, a simultaneous-equation model is also used to test the relative importance of the two explanations for each diagnosis or procedure. The results suggest that both explanations are valid, and that the relative importance of the practice or referral explanation varies by diagnosis or procedure, in ways consistent with clinical aspects of the various patient categories.
多项研究表明，针对特定诊断或治疗的患者数量较多的医院，其死亡率较低。在某些情况下，这些结果被解释为，处理这类患者较多的医生和医院工作人员会培养出更高的技能，从而带来更好的治疗效果——即“熟能生巧”假说。另一种解释是，治疗效果较好的医生和医院会吸引更多患者——即“选择性转诊模式”假说。我们利用来自900多家医院样本中17类患者的数据，研究了与医院规模相关的选定变量模式。为探究每种假说的合理性，我们还使用联立方程模型来检验针对每种诊断或治疗的两种解释的相对重要性。结果表明，两种解释都是合理的，而且实践或转诊解释的相对重要性因诊断或治疗而异，这与各类患者的临床情况相符。
