PCN223 - WHAT UNDERLIES THE OBSERVED HOSPITAL VOLUME-OUTCOME RELATIONSHIP?

Abstract

Studies of the hospital volume-outcome relationship have highlighted that a greater volume activity improves patient outcomes. While this finding has been known for years in health services research, most studies to date have failed to delve into what underlies this relationship. This study aimed to shed light on the basis of the hospital volume effect by comparing treatment modalities for epithelial ovarian carcinoma (EOC) patients. We used three clinical databases that contained exhaustive datasets of patients in first-line treatment for EOC in 2012 in three regions of France (n=355). Hospital volume activity was instrumented by the distance from patients’ homes to their hospital, and the population density. We used complete tumor resection as a quality indicator. We found that higher volume hospitals appear to more often make the right decisions in regard to how to treat patients, which contributes to the positive impact of hospital volume activities on patient outcomes. Based on our parameter estimates, we found that the rate of complete tumor resection would increase by 10% with centralized care, and by 6% if treatment decisions were coordinated by high volume centers compared to the ongoing organization of care. In both scenarios, the use of neoadjuvant chemotherapy would increase by 10%. As volume alone is an imperfect correlate of quality, policy makers need to know what volume is a proxy for in order to devise volume-based policies. Centralized care at high volume hospitals was the scenario that led to the highest average patient outcome. However, several barriers, such as the increase in patient travel distances, have prevented such a reform of the organization of care from being applied. An intermediate solution between centralized and decentralized care could be to make lower volume hospitals benefit from the expertise of higher volume hospitals when making treatment decisions.