A. Gandjour et Kw. Lauterbach, The relationship between provider volume and mortality rate: volume data of German centres of excellence, Z KARDIOL, 90(9), 2001, pp. 613
Citations number
21
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
The purpose of this study was to determine the percentage of centres of exc
ellence (COEs) in Germany that achieved, for selected diagnoses and interve
ntions, annual hospital or surgeon threshold volumes associated with a lowe
r mortality rate.
A systematic review and evaluation of the literature identified the most re
levant study for each diagnosis and intervention selected. Each diagnosis a
nd intervention was only considered if the most relevant source yielded a t
hreshold volume associated with a reduced mortality rate. COEs received que
stionnaires on the annual volume of such diagnoses and interventions for ea
ch department, providing physician (median), and senior consultant in 1999.
For most of the diagnoses and interventions considered, the percentage of C
OEs meeting their respective threshold volumes exceeded 50%. Exceptions wer
e carotid endarterectomy (performed in departments of general cardiac surge
ry) and liver transplantation. The percentage of providing physicians and s
enior consultants performing to the desired standard remained above 75% for
most of the diagnoses and interventions. Exceptions were surgeons dealing
with carotid endarterectomy, correcting congenital heart disease (both perf
ormed in departments of general cardiac surgery), and correcting primary hy
perparathyroidism.
That a smaller percentage of centres for general cardiac surgery, liver tra
nsplantation, and primary hyperparathyroidism operates at their threshold v
olumes may be due to a relative oversupply of centres specialising in these
treatments as well as a the lack of regional centres with a high referral
rate. Due to the country-specificity of studies performed on the relationsh
ip between volume and mortality rate, it is highly recommended that Germany
-specific volume-outcome studies be performed particularly in specialties w
ith relatively low case volumes.