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May 5, 2004

Hospital Volume and Quality

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2004;291(17):2077. doi:10.1001/jama.291.17.2077-a

To the Editor: Dr Peterson and colleagues1 reported that quality scores for coronary artery bypass graft (CABG) surgery were unrelated to the number of such procedures that hospitals performed. I have 3 concerns about their study.

First, hospitals with low volumes of CABG surgery may have less-stringent clinical indications, perhaps in an attempt to maintain a certain number of such procedures. Second, the risk-adjusted mortality rate in hospitals with 150 or fewer procedures per year was 28% greater than in hospitals with 450 or more procedures per year. If patients were able to make an informed choice, I believe many would opt for the hospital with the higher caseload. Third, larger health facilities enjoy economies of scale, enabling resources to be saved and used to improve health care coverage in other sectors.2 These potential advantages were not assessed by the authors.

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