Centralization, defined as the reorganization of healthcare services into fewer specialized units, is a common strategy to improve the outcomes of healthcare services. Centralization is thus based on the assumption that practice makes perfect, i.e. that higher hospital volumes result in better health outcomes. To date the volume-outcome relationship has been proved for several surgical procedures. In addition, there are also many non-surgical examples, such as dialysis, care for low birth weight infants as well as care for people living with HIV/Aids.
Following this, many countries such as the United States, Canada, the UK and Switzerland have established minimum volume standards for certain healthcare services, i.e. cut-offs in terms of a minimum number of a specific procedure. This minimum volume standard is then a necessary precondition for a provider to be allowed to perform this procedure in the future. In Germany minimum volume standards are currently in effect for ten procedures and healthcare services, e.g. liver transplantations, pancreatic surgeries as well as knee replacements.
With respect to research on centralization of healthcare services there is currently a major drawback in that outcomes considered are mainly at the patient level, while outcomes at the health system level such as travel times or costs are often neglected. Accordingly, we aim at developing a core outcome set (COS) for studies on centralization of healthcare services.
Professor Dr. Dawid Pieper, MPH, M.Sc. (Epidemiology)
Institute for Health Services and Health Systems Research
Center for Health Services Research Brandenburg,
Brandenburg Medical School Theodor Fontane (MHB)
Faculty of Health Sciences Brandenburg
Professor Dr. Tim Mathes, M.Sc. (Medical Biometry/Biostatistics), Diploma (Health Economics)
Department of Medical Statistics
University Medical Center Georg-August-University Göttingen
Stefanie Pfisterer-Heise, M.Sc. (Psychology)
Institute for Health Services and Health Systems Research
Center for Health Services Research Brandenburg,
Brandenburg Medical School Theodor Fontane (MHB)
Faculty of Health Sciences Brandenburg
Julia Scharfe, MPH
Institute for Health Services and Health Systems Research
Center for Health Services Research Brandenburg,
Brandenburg Medical School Theodor Fontane (MHB)
Faculty of Health Sciences Brandenburg
Charlotte Kugler, M.Sc. (Biotechnology)
Institute for Health Services and Health Systems Research
Center for Health Services Research Brandenburg,
Brandenburg Medical School Theodor Fontane (MHB)
Faculty of Health Sciences Brandenburg
Eni Shehu, M.A. (Physical Activity and Health)
Institute for Health Services and Health Systems Research
Center for Health Services Research Brandenburg,
Brandenburg Medical School Theodor Fontane (MHB)
Faculty of Health Sciences Brandenburg
Tobias Wolf, MPH
Institute for Health Services and Health Systems Research
Center for Health Services Research Brandenburg,
Brandenburg Medical School Theodor Fontane (MHB)
Faculty of Health Sciences Brandenburg
Disease Category: Effective practice/health systems
Disease Name: N/A
Age Range: 0 - 99
Sex: Either
Nature of Intervention: Any
- Clinical experts
- Patient/ support group representatives
- Researchers
- Health insurance company representatives
- COS (Other)
- Delphi process
- Focus group(s)
- Survey
- Systematic review
- Interview
Step 1 - A systematic review will be conducted to investigate what outcomes are measured in studies on minimum volume standards in hospitals as well as the effects of minimum volume standards in hospitals.
To gather information on what outcomes are meaningful in the respective stakeholder group, in Step 2 a total of three studies will be conducted:
Step 2a – A focus group with patient representatives on the topic of centralization will be carried out.
Step 2b – An interview study with representatives of the German medical societies as well as representatives of German health insurances on the topics of centralization as well as minimum volume regulations will be carried out.
Step 2c – An online survey with experts in the field of health services research will be performed.
Step 3 - A Delphi study will be performed to reach consensus on the COS across stakeholders.