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More Than Size Matters:  Comment on

Formosa Chen, MD; David Zingmond, MD; Clifford Ko, MD, MSHS
Arch Surg. 2010;145(2):186. doi:10.1001/archsurg.2009.270.
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Delivering high-quality health care is a priority, as is reducing health care disparities. Dr Epstein and colleagues build on earlier work that demonstrated that racial/ethnic minorities are less likely to be treated by high-volume providers, a proxy measure for expert, high-quality care. It is not surprising that numerous studies have found that in the current US health care system the disenfranchised tend to receive worse care and have worse outcomes. How to use these findings to improve health care quality for underserved populations is the challenge, and certain recommendations may be difficult to implement in practice. Regionalization—the blanket rerouting of use to a limited number of high-volume surgeons and/or hospitals—represents one approach. However, as demonstrated by Epstein and colleagues, there is categorical disparity in who sees high-volume providers. Hence, advancing this selective referral strategy to more procedures would likely increase racial/ethnic health care disparities.

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