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Back to the Future: Volume as a Quality Metric

At one time, volume was the major measure of quality because other measures were lacking. Now volume is getting renewed attention, and it seems common sense if practice makes perfect. While it’s not quite that straight forward, as Dr. Ashish K. Jha, discusses in a JAMA Forum article, volume does indeed matter but other factors can impact outcomes as well.

Quality leaders from 3 major academic health systems — Dartmouth-Hitchcock Medical Center, The Johns Hopkins Hospital and Health System, and the University of Michigan Health System — have begun a Take the Volume Pledge campaign to define a minimum annual volume threshold for hospitals and surgeons for surgeries.

Recommended volumes for 10 surgical procedures are being proposed by the group:

proposed ann surg vol jun15

Dr Jha mentions 2 issues for setting surgical volume standards: what to do about new surgeons, and the argument that setting  thresholds may be self-serving for high-volume surgeons or hospitals.


Jha AK. JAMA Forum: Back to the future: volume as a quality metric. JAMA News, June 10, 2015. http://newsatjama.jama.com/2015/06/10/jama-forum-back-to-the-future-volume-as-a-quality-metric

Sternberg S. Low volume hospitals – what to ask. US News & World Reports, May 18, 2015. http://www.usnews.com/news/articles/2015/05/18/low-volume-hospitals-what-to-ask


Clark C Limits urged on surgeries by low-volume providers. HealthLeaders Media, May 20, 2015.

Sternberg S. Hospitals move to limit low-volume surgeries. US News & World Reports, May 19, 2015. http://www.usnews.com/news/articles/2015/05/19/hospitals-move-to-limit-low-volume-surgeries

Sternberg S and Dougherty G. Risks are high at low-volume hospitals. US News & World Reports, May 18, 2015. http://www.usnews.com/news/articles/2015/05/18/risks-are-high-at-low-volume-hospitals

Posted by AHA Resource Center (312) 422-2050, rc@aha.org

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