A MANAGERIAL USE OF THE VOLUME-OUTCOME ASSOCIATION Elisabetta Listorti, PhD Student Politecnico di Torino Key words volume-outcome association hospital dimensioning mortality health policy health quality THE VOLUME-OUTCOME ASSOCIATION 30-day adjusted mortality rates Piano Nazionale Valutazione Esiti, 2011 Volume= Planning Relevance of managerial tools within healthcare, but with a strategical approach and clinical objectives Volume by facility The volume-outcome association Managerial and clinical perspective Recurring trend that associates higher volume of activity to better results, which in turn means better patients’ health conditions Why? Existence of learning curves More prepared medical staff Better structural organization in high-volume hospitals Outcomes= Quality Commitment for the uneven distribution of outcome quality levels within national contexts Assumptions Perspective THE OPERATIONAL RESEARCH MODEL Objective function Commissioner Objective: improving population health conditions • • • Outcome depends only on volume Omit external constraints No actors interactions Costs Constraints Demand Capacity Under/Overtreatment Expressed through the volume-outcome association Solution: Number of interventions to be allocated to hospitals, optimal in terms of patients health conditions Volume of activity of operation j performed in hospital i OBJECTIVE FUNCTIONS ANALYSIS Improving patients health conditions was translated as: 1. Minimize total mortality 2. Minimize the average mortality rate 3. Minimize the mortality rates variance 4. Minimize the mortality rates average range Drawing to different solutions: Unbalanced solution extremely high number of interventions in one facility, very low volumes in the remaining hospitals Priority: Quality Balanced solution: total volume equally divided by hospitals Priority: Equity CASE STUDIES Geographical distribution Specialization threshold Hospitals performance Which consequences has a threshold imposition, In terms of outcome? Volume Actual configuration (bladder cancer interventions, 2013, PNE data): What if we entered the model constraints on catchment area coverage? Negative consequences in terms of outcomes Mortality curve Minimum volume of activity imposed to hospitals Real outcomes Differences in outcomes, volumes being equal We can track hospitals performance and adjust the allocation based on their competences ON-GOING AND FUTURE RESEARCH Patients answer xij  xij +1 Volume of activity Patient choice Which factors affect patients hospital choice? Stochastic surgery demand and mortality rates Uncertainty Model application Territorial configurations robust to uncertainty Enriching the model of data information: Costs Capacity: Human resources and structural resources Network of wards, including oncology ones