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 patients. Hospital volume activity was instrumented by the distance from patients’ homes to their hospital, the population density, and the median net income of patient municipalities. 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.
Highlights
The volume outcome relationship (VOR) in health economics has been the subject of extensive investigation
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
The use of neoadjuvant chemotherapy would increase by 10%
Summary
The volume outcome relationship (VOR) in health economics has been the subject of extensive investigation. While several studies have identified differences in treatments according to hospital volume activities, none of them have linked these differences to patient outcomes to see whether they contributed to the observed VOR. 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%. Descriptive statistics In 2012, 355 patients were identified in first-line treatment for EOC and they were treated in 74 different hospitals in the Basse Normandie, Bourgogne and Rhone-Alpes region. The differences were analyzed using the Student’s t-test or the Chi square test
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
