Volume of procedures and outcome of treatment

BMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7383.280/a (Published 01 February 2003) Cite this as: BMJ 2003;326:280

NHS needs to understand relation more effectively

  1. Gareth Parry, senior research fellow,
  2. Janet Tucker, senior research fellow,
  3. William Tarnow-Mordi, professor, neonatology
  1. Medical Care Research Unit, ScHARR, University of Sheffield, Sheffield S1 4DA
  2. Dugald Baird Centre for Research on Women's Health, Department of Obstetrics and Gynaecology, University of Aberdeen, Aberdeen AB25 2ZL
  3. Westmead and Children's Hospital at Westmead, University of Sydney at Westmead Hospital, Hawkesbury Road, Wentworthville, NSW 2145, Australia
  4. Roskilde County, Department for Health, PO Box 170, DK-4000 Roskilde, Denmark
  5. Viborg Hospital, Heibergs Allé 4, DK-8800 Viborg, Denmark
  6. University Hospital Gentofte, Niels Andersens Vej 65, DK-2900 Hellerup, Denmark
  7. Copenhagen County, Stationsparken 27, DK-2600 Glostrup, Denmark
  8. University Hospital Herlev, Herlev Ringvej 75, DK-2730 Herlev, Denmark
  9. University Hospital Gentofte

    EDITOR—For procedures relying primarily on individual doctors or surgeons, evidence shows that patients have better outcomes treated by providers with high versus low volumes.1 Where care is shared over a group, evidence of a relation between volume and outcome is less strong. Current theories for such relations are “practice makes perfect” and “selective referral.” Halm criticises these theories as lacking robust empirical support and providing little explanation of how high volume may relate to better outcomes.2 One explanation of the relation may be the greater uptake of effective interventions in high compared with low volume hospitals.3 It is important to examine how the timing of the introduction of new therapies impacts on relations between volume and outcome. Often trials of …

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