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High-Volume Hospitals Better for Some Cancer Surgeries

High-Volume Hospitals Better for Some Cancer Surgeries

WASHINGTON—Sufficient evidence exists to suggest that patients
undergoing pancreatic and esophageal cancer surgery have lower mortality rates
at high-volume hospitals and that physicians and patients should consider this
fact in making treatment decisions, a report by the Institute of Medicine (IOM)
said.

The report, Interpreting the Volume-Outcome Relationship in the Context of
Cancer Care,
relies in part on a paper presented at an IOM workshop. In it,
Ethan A. Halm, MD, Clara Lee, MD, and Mark R. Chassin, MD, of the Mount Sinai
School of Medicine Department of Health Policy, New York, reviewed 20
population-based studies of surgical interventions for cancer. Three of the
studies looked at more than one form of cancer.

Although the studies differed in design, methodology, and definition of
high-volume and low-volume hospitals, "there is a consistency in the
published results," the IOM report said. "A higher-volume-better-outcome
association was observed in all but three of the studies reviewed (these three
studies showed no volume-outcome association)."

Two years ago, in a report titled Ensuring Quality Cancer Care, the IOM’s
National Cancer Policy Board recommended that "patients undergoing
procedures that are technically difficult to perform and have been associated
with higher mortality in lower volume settings receive care at facilities with
extensive experience."

The new report further confirms and documents the tie between volume and
outcome in difficult surgical procedures. However, "available evidence is
insufficient to say that cancer care is better or worse when offered by
specialized compared to generalist facilities or providers, or in managed care
versus fee-for-service environments," the report said.

After assessing the paper by Dr. Halm and his colleagues, other materials,
and the advice of workshop participants, the National Cancer Policy Board made
two recommendations.

First, it urged that "when a large and significant volume-outcome
relationship is established firmly by the literature through consistent
findings in multiple studies (ie, esophagectomy, pancreatectomy), volume should
be incorporated as a quality indicator into ongoing quality-of-care programs
and initiatives."

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