[Volume-outcome-relationship in total hip replacement--literature review and model calculation of the health care situation].
OBJECTIVE
The aim of this study was to assess the volume-outcome relationship of total hip replacement and the effects of its application on medical care in Germany.


METHODS
Electronic bibliographic databases, the reference lists of relevant articles and various health services research-related resources were searched and selected studies were assessed. Additionally, the consequences of implementing a regulation based on volume-outcome relations were calculated by using administrative data in different settings.


RESULTS
The results in the literature concerning defined outcome parameters are inconsistent, but a general correlation between high volume and low complication rate could be identified. Implementing a regulation based on volume-outcome relationship with cut-off points of 20/50 total hip replacements/year would lead to an exclusion of 216 (17%)/483 (38%) hospitals, respectively, from medical care. This would result in a reallocation of 2214 (1.4%)/11,476 (7.4%) patients/year, respectively (extrapolation).


CONCLUSIONS
The application of a minimum requirement regulation based on volume-outcome considerations in the German health care system must be performed very sensitively, because significant effects are to be expected.
Schräder
P
P
Sozialmedizin, Medizinischer Dienst der Spitzenverbände der Krankenkassen, Essen. p.schraeder@mds-ev.de
Rath
T
T
D003661:Decision Support Techniques; D005858:Germany / Q000453:epidemiology; D006622:Hip Prosthesis / Q000706:statistics & numerical data*; D006801:Humans; D010043:Outcome and Process Assessment, Health Care / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control*; D016016:Proportional Hazards Models; D011475:Prosthesis Failure; D040841:Resource Allocation / Q000379:methods*; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors