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Health Outcomes ResearchDr. Laurent G. Glance has been awarded an R01 grant from AHRQ to perform a critical analysis of whether "Regionalizing high-risk surgery by diverting patients from low-quality centers will lead to better population outcomes than diverting patients from low-volume centers." In the absence of a national quality report card, selective referral of patients to high-volume hospitals has been advocated for high-risk surgery on the grounds that procedure volume is a quality proxy. With the launching of the Leapfrog Group safety initiative, these policy recommendations are now being implemented in the private sector. Significant questions, however, have been raised regarding the strength of the evidence supporting the volume-outcome relationship. The primary objective of this grant is to investigate the implications of selectively referring patients to hospitals using "volume" standards as opposed to "quality" criteria. A secondary product of this project is to address another central issue pertaining to the use of administrative data for benchmarking performance - namely, that secondary diagnoses do not typically distinguish between complications and pre-existing conditions. The inability to separate the two is likely to lead to biased risk adjustment and inaccurate quality measures. The knowledge gained from this project will advance the field of quality measurement and will provide information in support of rational policy making regarding the regionalization of high-risk surgery on a national scale.
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