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01-10-2010 | Healthcare Policy and Outcomes

Assessing the Volume-Outcome Hypothesis and Region-Level Quality Improvement Interventions: Pancreas Cancer Surgery in Two Canadian Provinces

Authors: Marko Simunovic, MD, David Urbach, MD, Diane Major, PhD, Rinku Sutradhar, PhD, Nancy Baxter, MD, Teresa To, PhD, Adalsteinn Brown, DPhil, Dave Davis, MD, Mark N. Levine, MD

Published in: Annals of Surgical Oncology | Issue 10/2010

Abstract

Background

The volume-outcome hypothesis suggests that if increased provider procedure volume is associated with improved patient outcomes, then greater regionalization to high-volume providers should improve region-level outcomes. Quality improvement interventions for pancreas cancer surgery implemented in year 1999 in Ontario, Canada were designed to regionalize surgery to high-volume hospitals and decrease operative mortality. Similar interventions were not used in Quebec, Canada. We assessed the volume-outcome hypothesis and the impact of the Ontario quality improvement interventions.

Materials and Methods

Administrative databases helped identify pancreatic resections from years 1994 to 2004 and relevant patient and hospital characteristics. Hospitals were high-volume if they provided ≥10 procedures in a given calendar year. Outcomes were regionalization of surgery to high-volume providers and rates of operative mortality.

Results

From 1994 to 2004 the percentage of cases in high-volume hospitals increased from 33 to 71% in Ontario and from 36 to 76% in Quebec. Annual rates of operative mortality dropped in Ontario (10.4–2.2% or less) and changed little in Quebec (7.2–9.8%). Changes in measures over time in both provinces were similar before and after year 1999.

Conclusions

Regionalization was associated with improved operative mortality in Ontario but not in Quebec, undermining the volume-outcome hypothesis. The Ontario quality improvement interventions likely were of little influence since patterns in regionalization and operative mortality were similar before and after year 1999.

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Title: Assessing the Volume-Outcome Hypothesis and Region-Level Quality Improvement Interventions: Pancreas Cancer Surgery in Two Canadian Provinces
Authors: Marko Simunovic, MD
David Urbach, MD
Diane Major, PhD
Rinku Sutradhar, PhD
Nancy Baxter, MD
Teresa To, PhD
Adalsteinn Brown, DPhil
Dave Davis, MD
Mark N. Levine, MD
Publication date: 01-10-2010
Publisher: Springer-Verlag
Published in: Annals of Surgical Oncology / Issue 10/2010
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-010-1114-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Assessing the Volume-Outcome Hypothesis and Region-Level Quality Improvement Interventions: Pancreas Cancer Surgery in Two Canadian Provinces

Abstract

Background

Materials and Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Materials and Methods

Results

Conclusions

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