Hughes R G, Hunt S S, Luft H S
Center for Health Services Administration, Arizona State University, Tempe 85287.
Med Care. 1987 Jun;25(6):489-503. doi: 10.1097/00005650-198706000-00004.
A growing body of evidence indicates that certain surgical procedures exhibit a "volume-outcome" relationship in which a higher volume of patients undergoing a particular procedure at a hospital is associated with better outcomes for those patients. The proportion of a hospital's patients operated on by low-volume or less experienced surgeons also may be associated with poor patient outcomes and thus contribute to the hospital "volume-outcome" relationship. This paper analyzes the influence of hospital volume and the proportion of a hospital's patients operated on by low-volume surgeons on patient outcome for 10 procedures, controlling for other selected factors that may influence outcomes. The analysis is based on 503,662 patient abstracts from 757 hospitals. Results indicate that both hospital volume and the proportion of patients operated on by low-volume surgeons are related to quality of care as measured by patient outcomes. Higher hospital volume is positively related to better patient outcomes. These findings are consistent with earlier hospital "volume-outcome" research and add an additional set of procedures using more recent data to the evidence. Unlike previous research on surgeon volume, a positive relationship was found between higher percentage of patients operated on by low-volume surgeons and poorer hospital quality.
越来越多的证据表明，某些外科手术呈现出一种“手术量-结果”关系，即医院中接受特定手术的患者数量越多，这些患者的治疗结果就越好。医院中由低手术量或经验不足的外科医生进行手术的患者比例，也可能与患者的不良治疗结果相关，从而影响医院的“手术量-结果”关系。本文分析了医院手术量以及医院中由低手术量外科医生进行手术的患者比例对10种手术患者治疗结果的影响，并控制了其他可能影响治疗结果的选定因素。该分析基于来自757家医院的503,662份患者摘要。结果表明，医院手术量以及由低手术量外科医生进行手术的患者比例均与以患者治疗结果衡量的医疗质量相关。医院手术量越高，患者治疗结果越好。这些发现与早期关于医院“手术量-结果”的研究一致，并利用更新的数据为这一证据增添了另一组手术的相关内容。与之前关于外科医生手术量的研究不同，研究发现由低手术量外科医生进行手术的患者比例越高，医院质量越差。
