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Volume 341:1085-1086 September 30, 1999 Number 14
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The Relation between Volume and Outcome in Health Care

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 by Hannan, E. L.
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 by Thiemann, D. R.
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To the Editor: The analysis by Thiemann et al. (May 27 issue)1 of data from the Health Care Financing Administration's Cooperative Cardiovascular Project demonstrates a well-recognized inverse association between the number of patients treated at a hospital (hospital volume) — in this case, the number of Medicare patients with acute myocardial infarction — and mortality within 30 days after admission. The investigators estimate that about one third of the survival benefit in high-volume hospitals can be attributed to the use of aspirin, thrombolytic agents, beta-blockers, angiotensin-converting–enzyme inhibitors, and revascularization. The remaining two thirds is attributed to hospital volume.

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