High volume not always best

The conventional wisdom suggests that only hospitals that perform at least 400 angioplasties a year should be allowed to offer the procedure. A higher volume, the reasoning goes, leads to better outcomes.

But researchers at Yale and the University of Pennsylvania challenge that view in a study published in the Journal of the American College of Cardiology. The study of 362,748 angioplasties performed between 1998 and 2000 found comparable outcomes in medium- to very-high-volume hospitals. Yet some low-volume hospitals provided excellent care while some high-volume hospitals did not, said Saif S. Rathore, M.P.H., a lecturer in cardiovascular medicine, and one of the study’s authors.

“If you accept volume [as the only standard],” Rathore said, “you essentially consign all low-volume hospitals to being of poor quality and you give all high-volume hospitals a pass on quality. What we ought to be doing is identifying those hospitals or doctors that provide better quality of care.”