Volume and outcome in healthcare: implications for health policy

Over the past three decades, a growing body of research has shown that the outcomes of complex surgical procedures are better in hospitals that perform a large number of similar procedures (Halm et al. 2002; Luft et al. 1979). There has been increasing interest in policies that restrict certain surgical procedures to high-volume hospitals (Epstein 2002), a strategy often described as "regionalization." The intent of regionalization is to reduce the risk of poorer outcomes associated with treatment at low-volume hospitals, particularly for high-risk procedures such as coronary artery bypass graft and major pancreatic surgery.