Document Detail

Hospital volume and 30-day mortality for three common medical conditions.
MedLine Citation:
PMID:  20335587     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The association between hospital volume and the death rate for patients who are hospitalized for acute myocardial infarction, heart failure, or pneumonia remains unclear. It is also not known whether a volume threshold for such an association exists.
METHODS: We conducted cross-sectional analyses of data from Medicare administrative claims for all fee-for-service beneficiaries who were hospitalized between 2004 and 2006 in acute care hospitals in the United States for acute myocardial infarction, heart failure, or pneumonia. Using hierarchical logistic-regression models for each condition, we estimated the change in the odds of death within 30 days associated with an increase of 100 patients in the annual hospital volume. Analyses were adjusted for patients' risk factors and hospital characteristics. Bootstrapping procedures were used to estimate 95% confidence intervals to identify the condition-specific volume thresholds above which an increased volume was not associated with reduced mortality.
RESULTS: There were 734,972 hospitalizations for acute myocardial infarction in 4128 hospitals, 1,324,287 for heart failure in 4679 hospitals, and 1,418,252 for pneumonia in 4673 hospitals. An increased hospital volume was associated with reduced 30-day mortality for all conditions (P<0.001 for all comparisons). For each condition, the association between volume and outcome was attenuated as the hospital's volume increased. For acute myocardial infarction, once the annual volume reached 610 patients (95% confidence interval [CI], 539 to 679), an increase in the hospital volume by 100 patients was no longer significantly associated with reduced odds of death. The volume threshold was 500 patients (95% CI, 433 to 566) for heart failure and 210 patients (95% CI, 142 to 284) for pneumonia.
CONCLUSIONS: Admission to higher-volume hospitals was associated with a reduction in mortality for acute myocardial infarction, heart failure, and pneumonia, although there was a volume threshold above which an increased condition-specific hospital volume was no longer significantly associated with reduced mortality.
Joseph S Ross; Sharon-Lise T Normand; Yun Wang; Dennis T Ko; Jersey Chen; Elizabeth E Drye; Patricia S Keenan; Judith H Lichtman; Héctor Bueno; Geoffrey C Schreiner; Harlan M Krumholz
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, Non-P.H.S.    
Journal Detail:
Title:  The New England journal of medicine     Volume:  362     ISSN:  1533-4406     ISO Abbreviation:  N. Engl. J. Med.     Publication Date:  2010 Mar 
Date Detail:
Created Date:  2010-03-25     Completed Date:  2010-03-31     Revised Date:  2014-09-05    
Medline Journal Info:
Nlm Unique ID:  0255562     Medline TA:  N Engl J Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1110-8     Citation Subset:  AIM; IM    
Copyright Information:
2010 Massachusetts Medical Society
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MeSH Terms
Cross-Sectional Studies
Heart Failure / mortality*
Hospital Bed Capacity
Hospital Mortality*
Hospitalization / statistics & numerical data*
Hospitals / classification,  utilization
Hospitals, Teaching
Logistic Models
Myocardial Infarction / mortality*
Pneumonia / mortality*
Risk Adjustment
United States / epidemiology
Grant Support
K08 AG032886/AG/NIA NIH HHS; K08 AG032886/AG/NIA NIH HHS; K08 AG032886-01/AG/NIA NIH HHS; K08 AG032886-02/AG/NIA NIH HHS

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