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BMC Health Services Research
Published in: BMC Health Services Research 1/2015

Open Access 01-12-2015 | Research article

Minimum volume standards in German hospitals: do they get along with procedure centralization? A retrospective longitudinal data analysis

Authors: Werner de Cruppé, Marc Malik, Max Geraedts

Published in: BMC Health Services Research | Issue 1/2015

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Abstract

Background

Compliance with minimum volume standards for specific procedures serves as a criterion for high-quality patient care. International experiences report a centralization of the respective procedures. In Germany, minimum volume standards for hospitals were introduced in 2004 for 5 procedures (complex esophageal and pancreatic interventions; liver, kidney and stem cell transplantations), in 2006 total knee replacement was added. This study explores whether any centralization is discernible for these procedures in Germany.

Methods

A retrospective longitudinal analysis of secondary data serves to determine a possible centralization of procedures from the system perspective. Centralization means that over time, fewer hospitals perform the respective procedure, the case volume in high-volume hospitals increases together with their percentage of the annual total case volume, and the case volume in low-volume hospitals decreases together with their percentage of the annual total case volume. Using data from the mandatory hospital quality reports for the years 2006, 2008 and 2010 we performed Kruskal Wallis and chi-square tests to evaluate potential centralization effects.

Results

No centralization was found for any of the six types of interventions over the period from 2006 to 2010. The annual case volume and the number of hospitals performing interventions rose at differing rates over the 5-year period depending on the type of intervention. Seven percent of esophagectomies and 14 % of pancreatectomies are still performed in hospitals with less than 10 interventions per year.

Conclusions

For the purpose of further centralization of interventions it will be necessary to first analyze and then appropriately address the reasons for non-compliance from the hospital and patient perspective.
Literature
1.
Pieper D, Mathes T, Neugebauer E, Eikermann M. State of evidence on the relationship between high-volume hospitals and outcomes in surgery: A systematic review of systematic reviews. J Am Coll Surg. 2013;216:1015–1025.e18.CrossRefPubMed
2.
Birkmeyer JD, Siewers AE, Finlayson EVA, Stukel TA, Lucas FL, Batista I, et al. Hospital volume and surgical mortality in the United States. N Engl J Med. 2002;346:1128–37.CrossRefPubMed
3.
4.
Fareed N. Size matters: a meta-analysis on the impact of hospital size on patient mortality. Int J Evid Based Healthc. 2012;10:103–11.CrossRefPubMed
5.
Dimick JB, Birkmeyer Jr JD, Upchurch Jr GR. Measuring surgical quality: What’s the role of provider volume? World J Surg. 2005;29:1217–21.CrossRefPubMed
6.
Chowdhury MM, Dagash H, Pierro A. A systematic review of the impact of volume of surgery and specialization on patient outcome. Br J Surg. 2007;94:145–61.CrossRefPubMed
7.
Gooiker GA, van Gijn W, Post PN, van de Velde CJH, Tollenaar RAEM, Wouters MWJM. A systematic review and meta-analysis of the volume-outcome relationship in the surgical treatment of breast cancer. Are breast cancer patients better of with a high volume provider? Eur J Surg Oncol. 2010;36:S27–35.CrossRefPubMed
8.
Gooiker GA, van Gijn W, Wouters MWJM, Post PN, van de Velde CJH, Tollenaar RAEM, et al. Systematic review and meta-analysis of the volume-outcome relationship in pancreatic surgery. Br J Surg. 2011;98:485–94.CrossRefPubMed
9.
Goossens-Laan CA, Gooiker GA, van Gijn W, Post PN, Bosch JLHR, Kil PJM, et al. A systematic review and meta-analysis of the relationship between hospital/surgeon volume and outcome for radical cystectomy: an update for the ongoing debate. Eur Urol. 2011;59:775–83.CrossRefPubMed
10.
Gruen RL, Pitt V, Green S, Parkhill A, Campbell D, Jolley D. The effect of provider case volume on cancer mortality: systematic review and meta-analysis. CA Cancer J Clin. 2009;59:192–211.CrossRefPubMed
11.
Karthikesalingam A, Hinchliffe RJ, Loftus IM, Thompson MM, Holt PJ. Volume-outcome relationships in vascular surgery: the current status. J Endovasc Ther. 2010;17:356–65.CrossRefPubMed
12.
Markar SR, Karthikesalingam A, Thrumurthy S, Low DE. Volume-outcome relationship in surgery for esophageal malignancy: systematic review and meta-analysis 2000–2011. J Gastrointest Surg. 2012;16:1055–63.CrossRefPubMed
13.
Marlow NE, Barraclough B, Collier NA, Dickinson IC, Fawcett J, Graham JC, et al. Centralization and the relationship between volume and outcome in knee arthroplasty procedures. ANZ J Surg. 2010;80:234–41.CrossRefPubMed
14.
15.
Woo YL, Kyrgiou M, Bryant A, Everett T, Dickinson HO. Centralisation of services for gynaecological cancer. Cochrane Database Syst Rev. 2012;3:CD007945.PubMedPubMedCentral
16.
Tol JAMG, van Gulik TM, Busch ORC, Gouma DJ. Centralization of highly complex low-volume procedures in upper gastrointestinal surgery. A summary of systematic reviews and meta-analyses. Dig Surg. 2012;29:374–83.CrossRefPubMed
17.
Ravi P, Bianchi M, Hansen J, Trinh Q-D, Tian Z, Meskawi M, et al. Benefit in regionalisation of care for patients treated with radical cystectomy: a nationwide inpatient sample analysis. BJU Int. 2013;113(5):733–40.CrossRefPubMed
18.
Hewitt M, Simone JV, editors. Ensuring quality cancer care. Washington, DC: National Academy Press; 1999.
19.
20.
Learn PA, Bach PB. A decade of mortality reductions in major oncologic surgery: the impact of centralization and quality improvement. Med Care. 2010;48:1041–9.CrossRefPubMed
21.
Smaldone MC, Simhan J, Kutikov A, Canter DJ, Starkey R, Zhu F, et al. Trends in regionalization of radical cystectomy in three large northeastern states from 1996 to 2009. Urol Oncol. 2013;31:1663–9.CrossRefPubMed
22.
Simhan J, Smaldone MC, Canter DJ, Zhu F, Starkey R, Stitzenberg KB, et al. Trends in regionalization of adrenalectomy to higher volume surgical centers. J Urol. 2012;188:377–82.CrossRefPubMed
23.
Rosales-Velderrain A, Bowers SP, Goldberg RF, Clarke TM, Buchanan MA, Stauffer JA, et al. National trends in resection of the distal pancreas. World J Gastroenterol. 2012;18:4342–9.CrossRefPubMedPubMedCentral
24.
Massarweh NN, Flum DR, Symons RG, Varghese TK, Pellegrini CA. A critical evaluation of the impact of Leapfrog’s evidence-based hospital referral. J Am Coll Surg. 2011;212:150–159.e1.CrossRefPubMed
25.
26.
Mayer EK, Bottle A, Darzi AW, Athanasiou T, Vale JA. The volume-mortality relation for radical cystectomy in England: retrospective analysis of hospital episode statistics. BMJ. 2010;340:c1128.CrossRefPubMedPubMedCentral
27.
Skipworth RJE, Parks RW, Stephens NA, Graham C, Brewster DH, Garden OJ, et al. The relationship between hospital volume and post-operative mortality rates for upper gastrointestinal cancer resections: Scotland 1982–2003. Eur J Surg Oncol. 2010;36:141–7.CrossRefPubMed
28.
Crawford R, Greenberg D. Improvements in survival of gynaecological cancer in the Anglia region of England: are these an effect of centralisation of care and use of multidisciplinary management? BJOG. 2012;119:160–5.CrossRefPubMed
29.
Forshaw MJ, Gossage JA, Stephens J, Strauss D, Botha AJ, Atkinson S, et al. Centralisation of oesophagogastric cancer services: can specialist units deliver? Ann R Coll Surg Engl. 2006;88:566–70.CrossRefPubMedPubMedCentral
30.
Pal N, Axisa B, Yusof S, Newcombe RG, Wemyss-Holden S, Rhodes M, et al. Volume and outcome for major upper GI surgery in England. J Gastrointest Surg. 2008;12:353–7.CrossRefPubMed
31.
De Wilde RF, Besselink MGH, van der Tweel I, de Hingh IHJT, van Eijck CHJ, Dejong CHC, et al. Impact of nationwide centralization of pancreaticoduodenectomy on hospital mortality. Br J Surg. 2012;99:404–10.CrossRefPubMed
32.
Wouters MWJM, Krijnen P, Le Cessie S, Gooiker GA, Guicherit OR, Marinelli AWKS, et al. Volume- or outcome-based referral to improve quality of care for esophageal cancer surgery in The Netherlands. J Surg Oncol. 2009;99:481–7.CrossRefPubMed
33.
Gooiker GA, van der Geest LGM, Wouters MWJM, Vonk M, Karsten TM, Tollenaar RAEM, et al. Quality improvement of pancreatic surgery by centralization in the western part of the Netherlands. Ann Surg Oncol. 2011;18:1821–9.CrossRefPubMedPubMedCentral
34.
Lemmens VEPP, Bosscha K, van der Schelling G, Brenninkmeijer S, Coebergh JWW, de Hingh IHJT. Improving outcome for patients with pancreatic cancer through centralization. Br J Surg. 2011;98:1455–62.CrossRefPubMed
35.
Nobilio L, Fortuna D, Vizioli M, Berti E, Guastaroba P, Taroni F, et al. Impact of regionalisation of cardiac surgery in Emilia-Romagna, Italy. J Epidemiol Community Health. 2004;58:97–102.CrossRefPubMedPubMedCentral
36.
Miyata H, Motomura N, Kondo J, Takamoto S, Hasegawa T. Improving the quality of healthcare in Japan: a systematic review of procedural volume and outcome literature. Biosci Trends. 2007;1:81–9.PubMed
37.
Thompson M, Holt P, Loftus I, Forbes TL. Debate: Whether abdominal aortic aneurysm surgery should be centralized at higher-volume centers. J Vasc Surg. 2011;54:1208–14.CrossRefPubMed
38.
Forbes TL. Part two: The case against centralisation of abdominal aortic aneurysm surgery in higher volume centers. Eur J Vasc Endovasc Surg. 2011;42:414–7.CrossRefPubMed
39.
Stitzenberg KB, Sigurdson ER, Egleston BL, Starkey RB, Meropol NJ. Centralization of cancer surgery: Implications for patient access to optimal care. J Clin Oncol. 2009;27:4671–8.CrossRefPubMedPubMedCentral
40.
Stitzenberg KB, Meropol NJ. Trends in centralization of cancer surgery. Ann Surg Oncol. 2010;17:2824–31.CrossRefPubMed
41.
Mungall IJ. Trend towards centralisation of hospital services, and its effect on access to care for rural and remote communities in the UK. Rural Remote Health. 2005;5:390.PubMed
42.
Birkmeyer JD, Siewers AE, Marth NJ, Goodman DC. Regionalization of high-risk surgery and implications for patient travel times. JAMA. 2003;290:2703–8.CrossRefPubMed
43.
Payne S, Jarrett N, Jeffs D, Brown L. Implications of social isolation during cancer treatment. The implications of residence away from home during cancer treatment on patients’ experiences: a comparative study. Health Place. 2001;7:273–82.CrossRefPubMed
44.
45.
46.
de Cruppé W, Ohmann C, Blum K, Geraedts M. Evaluating compulsory minimum volume standards in Germany: how many hospitals were compliant in 2004? BMC Health Serv Res. 2007;7:165.CrossRefPubMedPubMedCentral
47.
Geraedts M, de Cruppé W, Blum K, Ohmann C. Implementation and effects of Germany’s minimum volume regulations - results of the accompanying research. Dtsch Arztebl. 2008;105:890–6.
48.
de Cruppé W, Ohmann C, Blum K, Geraedts M. Influence of minimum volumes on the structure of inpatient care. Gesundheitswesen. 2008;70:9–17.CrossRefPubMed
49.
Geraedts M, de Cruppé W, Blum K, Ohmann C. Distances to hospitals performing minimum volume relevant procedures in Germany 2004 to 2006. Gesundheitswesen. 2010;72:271–8.CrossRefPubMed
50.
de Cruppé W, Malik M, Geraedts M. Achieving minimum caseload requirements: an analysis of hospital quality control reports from 2004–2010. Dtsch Arztebl Int. 2014;111:549–55.PubMedPubMedCentral
51.
Simoes E, Bauer S, Schwoerer P, Schmahl FW. The structurizing effect of minimum quantitative requirements for inpatient care. Gesundheitswesen. 2005;67:96–100.CrossRefPubMed
52.
Roeder N, Wenke A, Heumann M, Franz D. Volume outcome relationship. Consequences of reallocation of minimum volume based on current German surgical regulations. Chirurg. 2007;78:1018–27.CrossRefPubMed
53.
Geraedts M, Kühnen C, de Cruppé W, Blum K, Ohmann C. Hospitals failing minimum volumes in 2004: reasons and consequences. Gesundheitswesen. 2008;70:63–7.CrossRefPubMed
54.
Geraedts M, Malik M, Jung O, de Cruppé W. Breast cancer centres in North Rhine-Westphalia - case volume trends 2004–2010. Gesundheitswesen. 2013;75:424–9.CrossRefPubMed
55.
Finlayson SRG, Birkmeyer JD, Tosteson A, Nease RF. Patient preferences for location of care: implications for regionalization. Med Care. 1999;37:204–9.CrossRefPubMed
Metadata
Title
Minimum volume standards in German hospitals: do they get along with procedure centralization? A retrospective longitudinal data analysis
Authors
Werner de Cruppé
Marc Malik
Max Geraedts
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2015
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-015-0944-7

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