The critical limitations of volume-outcome analysis.

Document Type

Article

Publication Date

7-1-2009

Institution/Department

MaineHealth, Urology

Journal Title

Urologic oncology

MeSH Headings

Health Services, Health Services Research, Hospitals, Humans, Male, Medical Oncology, Outcome Assessment, Health Care, Program Evaluation, Prostatic Neoplasms, Quality Assurance, Health Care, Quality Indicators, Health Care, Treatment Outcome, Urology, Workload

Abstract

There is a justified assumption that the patient outcome is in large part determined by the quality of the care they receive. For certain procedures outside of the field of urology, it has been demonstrated that higher surgical volume, either at the hospital or surgeon level is a proxy for higher quality of care. Multiple studies have followed this line of inquiry and attempted to show that volume may also predict outcome for certain urologic procedures. Review of the published studies shows that the association appears quite weak. However, the real weakness of this line of study is not so much in the findings, but in the universally used and critically flawed study methodology. This article demonstrates how a simple study design flaw has proved to be the Achilles heal of this entire line of research.

ISSN

1873-2496

First Page

422

Last Page

426

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