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JNCI Journal of the National Cancer Institute 2003 95(10):695-697; doi:10.1093/jnci/95.10.695
© 2003 by Oxford University Press
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Journal of the National Cancer Institute, Vol. 95, No. 10, 695-697, May 21, 2003
© 2003 Oxford University Press

EDITORIAL

Taking Action on the Volume–Quality Relationship: How Long Can We Hide Our Heads in the Colostomy Bag?

Thomas J. Smith, Bruce E. Hillner, Harry D. Bear

Affiliation of authors: T. J. Smith, B. E. Hillner, H. D. Bear, Massey Cancer Center of the Virginia Commonwealth University Health System, Richmond, VA.

Correspondence to: Thomas J. Smith, M.D., F.A.C.P., Virginia Commonwealth University, Division of Hematology/Oncology and Palliative Care, Massey Cancer Center of Virginia Commonwealth University, MCV Box 980230, Richmond, VA 23298–0230 (e-mail: tsmith@hsc.vcu.edu).

The first 10% of the full text of this article appears below.

WHAT DOES THE STUDY SHOW?

There is remarkably consistent evidence that the more experience doctors or health care systems have with a procedure, the better the results. At last count, 123 of 128 published studies showed some evidence of a "volume–quality" relationship (1,2). For oncology, the evidence is mostly consistent and often provides striking examples of markedly better outcomes with higher volume (3). There is even some evidence that outcomes can be improved with standardized care and clinical practice guidelines, among other things (4).

In this issue of the Journal, Hodgson et al. (5) identified 7257 patients with stage I–III rectal cancer from 1994 through 1997 in the California Cancer Registry to study the relationship of hospital volume with colostomy rates, 30-day mortality, and 2-year survival. The results look like a dose–response curve in . . . [Full Text of this Article]

WHAT ACTION SHOULD PATIENTS TAKE, BASED ON THE STUDY?

WHAT ACTION SHOULD HEALTH CARE PROFESSIONALS TAKE, AS A RESULT OF THE STUDY?

WHAT ACTION SHOULD PAYERS OR POLICY MAKERS TAKE, BASED ON THE STUDY?

TAKE HOME MESSAGE


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