PubMed · 10277906
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D Siehl. Perspectives.. https://pubmed.ncbi.nlm.nih.gov/10277906/
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BACKGROUND AND METHODS: For many complex surgical procedures there is an association between a low volume of procedures and an increased risk of death for the patients who undergo the procedures. We examined the effect of the volume of procedures at transplantation centers on the risk of death after liver transplantation. We analyzed all liver transplantations performed in the United States between October 1, 1987, and April 30, 1994. Because the results for 1987 to 1991 were largely similar to those from 1992 to 1994, we focused on the more recent period. RESULTS: Between January 1, 1992, and April 30, 1994, 47 centers performed 20 or fewer liver transplantations each per year (total, 837 transplantations) and were designated low-volume centers, and 52 centers performed more than 20 transplantations each per year (total, 6526) and were designated high-volume centers. The one-year mortality rate for the low-volume centers was 25.9 percent, as compared with 20.0 percent for the high-volume centers. Thirteen centers, all of which had low volumes, had one-year mortality rates of more than 40 percent. Low-volume centers that were affiliated with high-volume centers, such as pediatric transplantation programs, had results similar to those of the high-volume centers. The one-year mortality rate at unaffiliated low-volume centers was 28.3 percent, as compared with a rate of 20.1 percent for the group of all high-volume centers plus affiliated low-volume centers (P<0.001). CONCLUSIONS: As a group, liver-transplantation centers in the United States that perform 20 or fewer transplantations per year have mortality rates that are significantly higher than those at centers that perform more than 20 transplantations per year. Information regarding the outcome of liver transplantation at transplantation centers should be made widely available to the public in a timely manner.
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The set of ideas known as 'social role valorization' (SRV) has been highly influential in services for some client groups, but has rarely been applied in contexts of security. A framework of questions was designed to assist the application of the theory and principles of SRV in work with patients in special hospitals. Small-scale exercises in its use were introduced to explore the relevance and usefulness of SRV ideas in special hospital work. Evaluation indicated potential usefulness in a variety of contexts, especially when allied to consideration of values issues. No attempt was made in these exercises to incorporate SRV in the operational structures of the hospitals, a task that would require much more thought and work at an organizational level.