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Fewer Deaths in Larger, Busier Hospitals
Date:3/24/2010

However, increased volume is only one factor, researchers say

WEDNESDAY, March 24 (HealthDay News) -- Patients suffering from a heart attack, heart failure or pneumonia fare better in hospitals that see more of these patients than in those that see relatively few, a new study finds.

However, once the number of these patients reaches a certain threshold the outcomes are the same regardless of the size of the hospital, the researchers say.

"When you look straight on, you do see that the higher-volume hospitals have slightly better outcomes," said lead researcher Dr. Joseph S. Ross, an assistant professor of geriatrics and palliative medicine at Mount Sinai School of Medicine in New York City.

However, there is a lot of variability, he added. "You see some small hospitals with really good outcomes, but you also see small hospitals with bad outcomes," he said.

In addition, as hospital volume increases in general, "the importance of volume seems to decline," Ross said. "And you can point out a point at which increase in hospital volume wouldn't be expected to have any mortality benefit."

The researchers undertook the study because although the relationship between volume and outcomes in surgery is well-known, little is known about the connection between volume and outcomes for medical conditions, he said.

The report is published in the March 25 issue of the New England Journal of Medicine.

Using Medicare claims for 2004 to 2006, Ross's group collected data on almost 735,000 people hospitalized for heart attack, more than 1,324,000 sent to hospital for heart failure and more than 1,418,000 hospitalized with pneumonia.

The researchers found that, for each condition, increased hospital volume was associated with fewer deaths over 30 days.

However, once the number of patients treated for each condition reached a threshold level, outcomes remained the same.
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