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The volume-quality relationship: insufficient evidence for use as a quality indicator

Correspondence to:
Professor T A Sheldon
Department of Health Sciences, University of York, Heslington, York YO10 5DD, UK; tas5@york.ac.uk

Keywords: volume-quality relationship; quality indicator

The first 150 words of the full text of this article appear below.

Health service planners are increasingly trying to find ways to improve the quality and safety of health care. A wide range of approaches is being used from high level regulatory frameworks, use of clinical guidance and guidelines, to more micro level activity such as audit of care. None of these is easy; all require significant investment of resources, training, time and monitoring. The results are often uneven and result in variations in quality as initiatives diffuse unevenly through the system. It is understandable then that policy makers seek easier ways to deliver these improvements.

Research since the late 1970s seemed to point in the direction of a relatively constant relationship in health care—increased use of a hospital procedure reduces the mortality associated with it. The message emerging from a large number of studies, mainly from the USA, was that patients treated in hospitals which (or by clinicians who) . . . [Full text of this article]

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