April 1998

Research Trends

Quality of Care Makes A Difference
It is very important for patients to get information about the hospitals, physicians and other practitioners who will treat them. This is illustrated by two new studies reported in the March 1998 issue of the American Journal of Public Health.

The first study Hospital Volume Differences and Five-Year Survival from Breast Cancer describes an analysis of hospital discharge data on almost 48,000 women treated for breast cancer in New York state between 1984 and 1989. The results showed that there was a marked increase in long term survival of patients treated at hospitals performing a high volume of breast cancer surgery compared to other hospitals. All 266 hospitals in New York State performing breast surgery were included in the study. Compared with high-volume hospitals, the death rates at 5 years increased by 19% in moderate-volume, 30% in low-volume and 60% in very low-volume hospitals. The effect of volume on survival was true for all stages of breast cancer.

High volume hospitals were hospitals performing more than 150 breast cancer surgeries per year.

Moderate volume hospitals were hospitals performing 51 - 150 breast cancer surgeries per year.

Low volume hospitals were hospitals performing 11 - 50 breast cancer surgeries per year.

Very low volume hospitals were hospitals performing 10 or fewer breast cancer surgeries per year.

The second study Geographic Variations in Breast Cancer Mortality: Do Higher Rates Imply Elevated Incidence or Poorer Survival? found that women over the age of 55 in the northeast region of the United States have a higher death rate from breast cancer than women in the rest of the country. The study suggests that differences between the quality of breast cancer treatment provided women in the northeast and treatment provided women in the rest of the country could be a principal reason for the differences in death rates.

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