Hospital Volume and Patient Outcomes: The Case of Hip Fracture Patients

Patients achieve better outcomes at hospitals that treat larger numbers of patients with certain diagnoses or who are undergoing particular procedures. However, the causal direction underlying this relationship is less well understood. Do patients treated at institutions with higher volumes of patie...

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Bibliographic Details
Published in:Medical care 1988-11, Vol.26 (11), p.1057-1067
Main Authors: Hughes, Robert G., Garnick, Deborah W., Luft, Harold S., McPhee, Stephen J., Hunt, Sandra S.
Format: Article
Language:English
Subjects:
Aged
Female
Health outcomes
Hip fractures
Hip Fractures - mortality
Hip Fractures - therapy
Hospital Bed Capacity
Hospital beds
Hospitals, General - standards
Humans
Length of Stay
Male
Medical referrals
Morbidity
Mortality
Nonprofit hospitals
Nursing homes
Outcome and Process Assessment (Health Care)
Patient Transfer
Physicians
Quality of Health Care
Referral and Consultation
United States
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Summary:Patients achieve better outcomes at hospitals that treat larger numbers of patients with certain diagnoses or who are undergoing particular procedures. However, the causal direction underlying this relationship is less well understood. Do patients treated at institutions with higher volumes of patients achieve better outcomes because the hospital staff and physicians have gained expertise by practice (the "practice makes perfect" hypothesis)? Do hospitals with a community reputation for excellent results attract higher volumes of patients because primary care physicians refer patients to specialists who practice there (the "selective referral" hypothesis)? Or, are both explanations important? This article addresses this question through a detailed analysis of patients with a particular diagnosis: hip fracture. In addition, two measures of patient outcomes are compared: long hospital stays as a proxy for in-hospital complications and in-hospital death.
ISSN:0025-7079
1537-1948
DOI:10.1097/00005650-198811000-00004