Résumé :
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[BDSP. Notice produite par INIST-CNRS FTs1OR0x. Diffusion soumise à autorisation]. Context : Evidence-based selective referral strategies are being used by an increasing number of insurers to ensure that medical care is provided by high-quality providers. In the absence of direct-quality measures based on patient outcomes, the standards currently in place for many conditions rely on indirect-quality measures such as patient volume. Objectives : To assess the potential usefulness of volume as a quality indicator for very low-birth-weight (VLBW) infants and compare volume with other potential indicators based on readily available hospital characteristics and patient outcomes. Design, Setting, and Participants : A retrospective study of 94110 VLBW infants weighing 501 to 1500 g born in 332 Vermont Oxford Network hospitals with neonatal intensive care units between January 1,1995, and December 31,2000. Main Outcome Measures : Mortality among VLBW infants prior to discharge home ; detailed case-mix adjustment was performed by using patient characteristics available immediately after birth. Results In hospitals with less than 50 annual admissions of VLBW infants, an additional 10 admissions were associated with an 11% reduction in mortality (95% confidence interval [Cl], 5% - 16% ; P<. the annual volume of admissions only explained variation across hospitals in mortality rates and other readily available hospital characteristics an additional historical was not significantly related to implying that cannot prospectively identify high-quality providers. contrast lowest quintile between were found have lower ratio cl p highest had higher percentage level forecasted by quintiles based on patient compared with for volume. conclusions : referral vlbw infants indirect-quality indicators such as may be minimally effective. direct measures outcomes are more useful quality purposes selective they better predictors future among providers could save lives.>
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