P Schräder1, T Rath. 1. Sozialmedizin, Medizinischer Dienst der Spitzenverbände der Krankenkassen, Essen. p.schraeder@mds-ev.de
Abstract
AIM: The aim of this study was to assess the volume-outcome relationship of total hip replacement and the effects of its application on medical care in Germany. METHOD: Electronic bibliographic databases, the reference lists of relevant articles and various health services research-related resources were searched and selected studies were assessed. Additionally, the consequences of implementing a regulation based on volume-outcome relations were calculated by using administrative data in different settings. RESULTS: The results in the literature concerning defined outcome parameters are inconsistent, but a general correlation between high volume and low complication rate could be identified. Implementing a regulation based on volume-outcome relationship with cut-off points of 20/50 total hip replacements/year would lead to an exclusion of 216 (17%)/483 (38%) hospitals, respectively, from medical care. This would result in a reallocation of 2214 (1.4%)/11,476 (7.4%) patients/year, respectively (extrapolation). CONCLUSION: The application of a minimum requirement regulation based on volume-outcome considerations in the German health care system must be performed very sensitively, because significant effects are to be expected.
AIM: The aim of this study was to assess the volume-outcome relationship of total hip replacement and the effects of its application on medical care in Germany. METHOD: Electronic bibliographic databases, the reference lists of relevant articles and various health services research-related resources were searched and selected studies were assessed. Additionally, the consequences of implementing a regulation based on volume-outcome relations were calculated by using administrative data in different settings. RESULTS: The results in the literature concerning defined outcome parameters are inconsistent, but a general correlation between high volume and low complication rate could be identified. Implementing a regulation based on volume-outcome relationship with cut-off points of 20/50 total hip replacements/year would lead to an exclusion of 216 (17%)/483 (38%) hospitals, respectively, from medical care. This would result in a reallocation of 2214 (1.4%)/11,476 (7.4%) patients/year, respectively (extrapolation). CONCLUSION: The application of a minimum requirement regulation based on volume-outcome considerations in the German health care system must be performed very sensitively, because significant effects are to be expected.