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Volume-quality correlation not clear cut, study says

For diseases such as pneumonia, higher patient volume could mean worse physician performance.

By Kevin B. O'Reilly, amednews staff. May 1, 2006.

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Practice makes perfect? Not always. That's the finding of a recent study that sought to find out whether physicians who cared for a higher volume of pneumonia patients in a given year were more likely to follow quality guidelines and achieve superior outcomes.

Hundreds of studies have used patient volume as a proxy in quality measurement for high-risk surgical procedures, such as coronary bypass artery graft or care for complex diseases such as HIV/AIDS. Nearly 70% of studies examining physician performance in those areas found a statistically significant association between higher patient volume and superior outcomes, according to a 2002 medical literature review published in the Annals of Internal Medicine.

But the much-touted volume-outcome correlation appears to fall apart for care such as pneumonia, according to a study published in the Feb. 21 Annals of Internal Medicine.

The evaluation of 9,741 doctors who cared for 13,480 patients admitted to hospitals for pneumonia found little variation between physicians who cared for as few as two patients and those who cared for as many as 29 over two six-month periods. In fact, physicians with the highest volume of pneumonia patients delivered worse care on some measures. The results were similar at the hospital level.

"We were surprised that we didn't find an association in the direction we expected, and in fact, at least for several quality measures, we found just the opposite sort of association," said Peter K. Lindenauer, MD, lead author of the study and medical director of clinical information systems at Baystate Health Systems in Springfield, Mass.