National Academies Press: OpenBook

Interpreting the Volume-Outcome Relationship in the Context of Health Care Quality: Workshop Summary (2000)

Chapter: Why Does the Volume-Outcome Relationship Matter? Who Cares and How Could it Be Used?

« Previous: Introduction
Suggested Citation:"Why Does the Volume-Outcome Relationship Matter? Who Cares and How Could it Be Used?." Institute of Medicine. 2000. Interpreting the Volume-Outcome Relationship in the Context of Health Care Quality: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/10005.
×

WHY DOES THE VOLUME–OUTCOME RELATIONSHIP MATTER? WHO CARES AND HOW COULD IT BE USED?

To set the context for the discussion, Dr. John Eisenberg, in opening remarks to workshop participants, identified a diverse set of potential users of information on the volume–outcome relationship.

Health Insurance Purchasers and Health Plans

Health insurance purchasers could use findings from research on the volume–outcome relationship to stipulate “evidence-based referrals” in contracts with health plans. Such a program is being explored by the Leapfrog Group, a coalition of employers interested in improving the quality of care for employees. In addition, employers could make information about the relationship between volume and outcome directly available to employees (e.g., on a company intranet site) and encourage employees to choose hospitals and providers based on available evidence. Similarly, health plans could direct members to high-volume providers.

Consumers

Information about the relationship between volume and outcome could be provided more broadly through public websites, via advocacy groups, or as part of widely distributed quality report cards. In New York State, for example, information on the volume of cardiovascular and other procedures performed by individual surgeons and by hospitals is available through the Center for Medical Consumers, a nonprofit advocacy organization (www.medicalconsumers.org).

Insurers

Insurers must decide which new technologies or services to include in their benefit packages and, sometimes, the conditions under which these new service will be provided. For a new technology, insurers could offer interim service coverage until any volume–outcome relationship can be established. Once a relationship became apparent, coverage could be conditional on its provision in high-volume settings.

Hospital Administrators

Hospital administrators could, based on a positive volume–outcome relationship, decide to credential providers according to their volume of procedures or number of hospital admissions. Staffing decisions could also be affected. For some services, patients might be triaged to specialty units within hospitals, in part to ensure that providers have a sufficient volume to maintain their skills. One of the tenets of disease management is that assigning patients to certain disease-specific programs or institutions will improve care. This is not entirely related to volume, but evidence of a volume –outcome relationship for certain services could foster the development of specialty services, concentrating patients into settings with high volume.

Regulators

A few states have certificate of need (CON) legislation, a regulatory mechanism for review and approval of capital expenditures and service capacity expansions by health care facilities. In

Suggested Citation:"Why Does the Volume-Outcome Relationship Matter? Who Cares and How Could it Be Used?." Institute of Medicine. 2000. Interpreting the Volume-Outcome Relationship in the Context of Health Care Quality: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/10005.
×
Page 3
Next: How is Volume Related to Quality in Health Care? »
Interpreting the Volume-Outcome Relationship in the Context of Health Care Quality: Workshop Summary Get This Book
×
MyNAP members save 10% online.
Login or Register to save!
Download Free PDF
  1. ×

    Welcome to OpenBook!

    You're looking at OpenBook, NAP.edu's online reading room since 1999. Based on feedback from you, our users, we've made some improvements that make it easier than ever to read thousands of publications on our website.

    Do you want to take a quick tour of the OpenBook's features?

    No Thanks Take a Tour »
  2. ×

    Show this book's table of contents, where you can jump to any chapter by name.

    « Back Next »
  3. ×

    ...or use these buttons to go back to the previous chapter or skip to the next one.

    « Back Next »
  4. ×

    Jump up to the previous page or down to the next one. Also, you can type in a page number and press Enter to go directly to that page in the book.

    « Back Next »
  5. ×

    Switch between the Original Pages, where you can read the report as it appeared in print, and Text Pages for the web version, where you can highlight and search the text.

    « Back Next »
  6. ×

    To search the entire text of this book, type in your search term here and press Enter.

    « Back Next »
  7. ×

    Share a link to this book page on your preferred social network or via email.

    « Back Next »
  8. ×

    View our suggested citation for this chapter.

    « Back Next »
  9. ×

    Ready to take your reading offline? Click here to buy this book in print or download it as a free PDF, if available.

    « Back Next »
Stay Connected!