Abstract
- Three domains are accepted as indicators that make the quality of hospital care quantifiable and transparent: process, structure and outcome. - In recent years volume thresholds for surgical interventions have been added as new quality indicators, rendering the assumption that more volume leads to better outcomes. - This assumption has been established for many procedures in peer-reviewed literature since the 1970s. - Although there is consensus about the fact that volume is a proxy measure for other factors influencing the outcome of care, available research does not shed much light on the mechanisms underlying the volume-outcome relationship. - Moreover, the methodological quality of the available research has several limitations. - Despite the incomplete substantiation, volume thresholds are now embedded in 'risk-based' supervision by the health inspectorate as well as purchasing policies by health insurers.
