[Experience in orthopaedic surgery with minimum provider volumes].
The implementation of minimum provider volumes in orthopaedic surgery appears to be logically evident. A general volume outcome relationship could be found for total knee and hip replacement on a high level of evidence, but no definite threshold value could be identified. For other orthopaedic procedures the evaluated data hint at a volume outcome relationship but do not prove one. Preliminary model calculations on the effects of a regulation based on volume outcome considerations concerning medical care in Germany show that, though for total hip and knee replacement quite a large number of hospitals would be excluded from medical care, the number of patients to be reallocated would be small. Since 1 January 2007 a minimum provider volume of 50 total knee replacements per year per hospital has been mandatory in Germany. The further application of a minimum requirement regulation based on volume outcome considerations in the German health care system must be performed very carefully, because significant effects are to be expected.
Schräder
P
P
BQS Bundesgeschäftsstelle Qualitätssicherung gGmbH, Kanzlerstrasse 4, Düsseldorf, Germany. peter.schraeder@bqs-online.de
Ewerbeck
V
V
D019644:Arthroplasty, Replacement, Hip / Q000331:legislation & jurisprudence* / Q000401:mortality / Q000592:standards* / Q000706:statistics & numerical data; D019645:Arthroplasty, Replacement, Knee / Q000331:legislation & jurisprudence* / Q000401:mortality / Q000592:standards* / Q000706:statistics & numerical data; D019985:Benchmarking / Q000331:legislation & jurisprudence / Q000592:standards; D002983:Clinical Competence / Q000331:legislation & jurisprudence* / Q000592:standards* / Q000706:statistics & numerical data; D005858:Germany; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D015233:Models, Statistical; D009313:National Health Programs / Q000331:legislation & jurisprudence*; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D011785:Quality Assurance, Health Care / Q000331:legislation & jurisprudence* / Q000592:standards* / Q000706:statistics & numerical data; D016019:Survival Analysis; D014600:Utilization Review / Q000706:statistics & numerical data