Hughes R G, Garnick D W, Luft H S, McPhee S J, Hunt S S
School of Health Administration and Policy, Arizona State University, Tempe 85287-4506.
Med Care. 1988 Nov;26(11):1057-67. doi: 10.1097/00005650-198811000-00004.
Patients achieve better outcomes at hospitals that treat larger numbers of patients with certain diagnoses or who are undergoing particular procedures. However, the causal direction underlying this relationship is less well understood. Do patients treated at institutions with higher volumes of patients achieve better outcomes because the hospital staff and physicians have gained expertise by practice (the "practice makes perfect" hypothesis)? Do hospitals with a community reputation for excellent results attract higher volumes of patients because primary care physicians refer patients to specialists who practice there (the "selective referral" hypothesis)? Or, are both explanations important? This article addresses this question through a detailed analysis of patients with a particular diagnosis: hip fracture. In addition, two measures of patient outcomes are compared: long hospital stays as a proxy for in-hospital complications and in-hospital death.
在治疗大量患有特定诊断疾病或正在接受特定手术的患者的医院中，患者能取得更好的治疗效果。然而，这种关系背后的因果方向却不太为人所理解。在患者数量较多的机构接受治疗的患者能取得更好的治疗效果，是因为医院工作人员和医生通过实践获得了专业技能（“熟能生巧”假说）吗？因治疗效果出色而在社区享有声誉的医院吸引了更多患者，是因为初级保健医生将患者转诊至在那里执业的专科医生（“选择性转诊”假说）吗？还是说这两种解释都很重要？本文通过对患有特定诊断疾病（髋部骨折）的患者进行详细分析来探讨这个问题。此外，还比较了两种患者治疗效果的衡量指标：作为住院并发症替代指标的长时间住院以及住院死亡情况。
