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Over the past decade, the U.S. health care system has witnessed rapid and dramatic changes in the financing and organization of health services. These shifts have been accompanied by extensive public policy discussions over whether cost containment can be achieved while preserving the quality of health care. Health care providers and researchers have recognized that there is insufficient knowledge about “quality” care that can be used to guide decisions that providers and patients must make in everyday clinical practices. Measuring outcomes is widely considered an essential component of quality assessments because good outcomes usually reflect high quality in the process of care. Much of the health services literature is devoted to investigations of how the process and structure of health care delivery are associated with health outcomes. Patients who receive care in hospitals that perform a high volume of procedures have been shown in several studies (1‐5) to have outcomes that are superior to those for patients undergoing procedures in institutions that perform a lower volume. In this issue of the Journal, Yao and Lu-Yao (6) investigate the relationship between the hospital volume of radical prostatectomy for clinically localized prostate cancer and selected postsurgical outcomes. To our knowledge, this is the first study to assess the volume‐outcome relationship for radical prostatectomy. Approximately 180 000 men in the United States are diagnosed with prostate cancer each year (7), and an estimated 60 000 annually undergo radical prostatectomy as initial therapy for clinically localized prostate cancer. About half of these procedures are performed on men 65 years old or older. Focusing on this age group using Medicare claims data, Yao and Lu-Yao demonstrate that men undergoing radical prostatectomy in hospitals performing a higher volume of procedures had a lower risk of re-admissions, serious complications, and 30-day postsurgical mortality. While these results are clearly presented, they also raise questions about methods, interpretation, and application of volume‐outcome studies. The Medicare claims data offer the advantages of being

Radical Prostatectomy: Does Higher Volume Lead to Better Quality?