According to background information in the article, evidence-based selective referral strategies are being used by an increasing number of insurers to ensure that medical care is provided by high-quality providers and to make sure that patients with high-risk conditions are treated in hospitals with the best outcomes. In the absence of direct-quality measures based on patient outcomes, the standards currently in place for many conditions rely on indirect-quality measures such as patient volume.
Jeannette A. Rogowski, Ph.D., of RAND, Arlington, Va., and colleagues assessed the potential usefulness of indirect-quality indicators such as patient volume for very low birth weight (VLBW) infants and compared indirect-quality indicators with direct measures, such as survival rate at a hospital.
The study included 94,110 VLBW infants weighing 501 to 1500 grams (17.7 to 53 ounces) born in 332 Vermont Oxford Network hospitals with neonatal intensive care units (NICU) between January 1, 1995, and December 31, 2000.
The researchers found that in hospitals with less than 50 annual admissions of VLBW infants, an additional 10 admissions were associated with an 11 percent reduction in mortality. "The annual volume of admissions only explained 9 percent of the variation across hospitals in mortality rates, and other readily available hospital characteristics explained an additional 7 percent. Historical volume was not significantly related to mortality rates in 1999-2000, implying that volume cannot prospectively identify high-quality providers," the authors write.
In contrast, hospitals in the lowest mortality quintil
Contact: Warren Robak
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