Het volume van chirurgische ingrepen en de impact ervan op ... - KCE

218 Volume Outcome KCE reports 113
Regardless of the desirability of centralisation, it is clear that no programme will ever
succeed in getting all high-risk procedures into high-volume centres. Therefore, some
authors argue that instead of centralisation, it is probably worthwhile to develop
strategies for improving care in ALL hospitals, even low volume ones. This should be
done by setting a goal of improving surgical quality of care by improving the processes
of care.
Anyway, the merits and drawbacks of centralisation of health care are beyond the scope
of this report. Our analyses were not intended to determine thresholds but were
primarily designed to assess the feasibility of a volume outcome study with Belgian
administrative data and to validate the existence of volume-outcome associations.
The fact that this study is based on relatively old data (2004) calls for some caution in
the effects observed. Many changes have been introduced in our health care system
since 2004. Fusion of hospitals, creation of Belgian cancer registry, introduction of the
multidisciplinary consultations in oncology, introduction of minimal volumes in the
treatment of breast cancer, etc… All those factors have a potential impact on the
quality of care. All our results are thus valid for the year 2004, but might not be
applicable now.
Our final conclusion is that Belgian administrative data linked to registry data can be an
adequate tool to study the volume outcome relationship, provided necessary
precautions are taken.