[Volume outcome relationship. Consequences of reallocation of minimum volume based on current German surgical regulations].
BACKGROUND
Consequences of the volume outcome relationship are controversial. Objectification based on data analysis is strongly needed. The aim of this publication was to analyse the effects of volume outcome reallocations based on German inpatient data.


METHODS
The analysis based on inpatient data of the Krankenhauszweckverband Koeln, Bonn und Region (Hospital Association of the Cologne and Bonn Region) of 2002 and 2005. Relevant data sets were identified according to the effects of current German regulations on volume outcome on the special fields liver transplant, kidney transplant, complex pancreatic surgery, and complex oesophageal surgery.


RESULTS
The effects of current German regulations on volume outcome results differed greatly between the four surgical specialities. There were fewer effects on kidney transplant, but due to an already very high level of centralisation 34% (oesophagus) and 8% (pancreas) of the hospitals stopped related surgery. This affected 8.9% (oesophagus) and 2.2% (pancreas) of related cases.


CONCLUSIONS
Concentration and the formation of specialised medical centres are results of the implementation of volume outcome relationships. The quality of medical treatment does not automatically improve from this development. It is necessary to analyse any correlation between quality and frequency of treatment or other criteria such as know-how, structure and process management, and multidisciplinarity.
Roeder
N
N
DRG-Research-Group, Universitätsklinikum Münster, Domagkstrasse 25, Münster, Germany. roeder@smc.uni-muenster.de
Wenke
A
A
Heumann
M
M
Franz
D
D
D019985:Benchmarking / Q000331:legislation & jurisprudence / Q000592:standards; D002983:Clinical Competence / Q000331:legislation & jurisprudence* / Q000592:standards* / Q000706:statistics & numerical data; D004935:Esophageal Diseases / Q000401:mortality / Q000601:surgery; D005858:Germany; D006801:Humans; D016030:Kidney Transplantation / Q000331:legislation & jurisprudence / Q000401:mortality / Q000592:standards / Q000706:statistics & numerical data; D016031:Liver Transplantation / Q000331:legislation & jurisprudence / Q000401:mortality / Q000592:standards / Q000706:statistics & numerical data; D009313:National Health Programs / Q000331:legislation & jurisprudence*; D017063:Outcome Assessment, Health Care / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D010182:Pancreatic Diseases / Q000401:mortality / Q000601:surgery; D011785:Quality Assurance, Health Care / Q000331:legislation & jurisprudence* / Q000592:standards* / Q000706:statistics & numerical data; D013038:Specialization / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data / Q000639:trends; D013514:Surgical Procedures, Operative / Q000331:legislation & jurisprudence* / Q000401:mortality / Q000592:standards* / Q000706:statistics & numerical data; D016019:Survival Analysis; D014600:Utilization Review / Q000706:statistics & numerical data