Flood A B, Scott W R, Ewy W
Med Care. 1984 Feb;22(2):98-114.
The effect of a greater volume of patients with similar conditions being treated at a hospital on the outcomes achieved is studied using a variety of categories of patients, 15 surgical and 2 medical, and involving 550,000 patients treated in over 1,200 nonfederal United States acute care hospitals. After demonstrating that there are significant differences in the outcomes of patients, taking into account patient health status, the authors examine the impact of being treated in a hospital with a high or low volume of similar patients. Strong and consistent evidence is found that high volume is associated with better outcomes for surgical patients, which supports regionalizing patient care by procedure. Two additional variables, relative difficulty of the procedure and risk level of the patients, are analyzed to determine whether they change the relationship between volume and outcome. Some evidence is found that low-volume hospitals are associated with the poorest outcome for low-risk surgical patients. The evidence for medical patients is weak and mixed. Possible alternative explanations for the observed findings for surgical and medical patients are discussed.
研究人员利用多种类型的患者（15种外科手术患者和2种内科患者），对医院治疗更多患有相似病症患者的数量对治疗结果的影响进行了研究，这些患者涉及美国1200多家非联邦急症护理医院治疗的55万名患者。在证明了考虑患者健康状况后患者治疗结果存在显著差异之后，作者研究了在相似患者数量多或少的医院接受治疗的影响。研究发现了有力且一致的证据，即手术患者数量多与更好的治疗结果相关，这支持了按手术程序对患者护理进行区域化。分析了另外两个变量，即手术程序的相对难度和患者的风险水平，以确定它们是否会改变数量与结果之间的关系。研究发现一些证据表明，低手术量医院与低风险手术患者最差的治疗结果相关。内科患者的证据薄弱且参差不齐。讨论了对外科和内科患者观察结果的可能替代解释。
