Can regionalization decrease the number of deaths for children who undergo cardiac surgery?
In Reply. We appreciate the interest in our paper displayed by Smith and Powell. Their questions reflect frequently raised concerns regarding regionalization. We hope to further clarify some important issues. As pediatric cardiac specialists, our ultimate goal is to provide quality care and improve outcomes for children with heart disease. As our study demonstrates,1 regionalization of services by referring patients from low-volume hospitals to high-volume hospitals is one way to achieve these goals. However, there are many other ways in which quality of care for children with heart disease can be improved. In the discussion section of our article, we suggest that quality assurance programs, selective use of clinical pathways, and continuing education of medical personnel can all contribute to improvements in quality of care. In evaluating these strategies, both cost-effectiveness and access to care must be considered. Elucidation of these complex issues is beyond the scope of this dia
