Authors' objectives:

This report aims to provide a summary of the evidence on the relationship between hospital or physician volume of activities and the quality of health care.

Authors' recommendations: There is no evidence to suggest a general relationship between volume of activities and quality of health care. The relationship must be studied separately for each procedure or diagnosis in question. In surgical treatment of cancer of the esophagus, pancreas and liver there is evidence that patients treated in high volume hospitals or by high volume surgeons have better survival. For the cardiovascular procedures abdominal aortic aneurysms, carotid endarterectomy, pediatric cardiac surgery, acute myocardial infarction and PTCA there seems to be an effect of hospital and/or surgeon volume on mortality or morbidity. For organ transplantations, patients treated in high volume centers have better long term survival and organ survival than patients treated in low volume centers. In the treatment of AIDS, patients treated in high volume hospitals have better survival than patients treated in low volume hospitals. The volume - outcome relationship has been extensively studied in treatment of traumas, and there is no consistent relationship between hospital volume and outcome. For orthopaedic procedures (hip or knee arthroplasty or hip fracture) the results from the literature is inconsistent. The outcome studied is mortality or morbidity, and most have too short a follow-up to reveal complications such as revision rate. The report also documents the activities of selected procedures in Norwegian hospitals. Treatment of aortic aneurysm and patients with colorectal, esophagal or pancreas cancer is spread between many hospitals, some with a volume of only 1-2 procedures each year. In some instances this is due to emergency admissions, but also elective procedures were performed in hospitals with low volumes.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.nokc.no/

Year Published: 2001

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Norway

Organisation Name: Norwegian Institute of Public Health

Contact Address: Universitetsgata 2, Postbox 7004 St. Olavs plass, NO-0310 Oslo NORWAY. Tel: +47 23 25 50 00; Fax: +47 23 25 50 10;

Contact Name: Berit.Morland@nokc.no, dagny.fredheim@nokc.no

Contact Email: Berit.Morland@nokc.no, dagny.fredheim@nokc.no

Copyright: The Norwegian Knowledge Centre for the Health Services