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BMC Health Services Research
Published in: BMC Health Services Research 1/2014

Open Access 01-12-2014 | Research article

Association between hospital case volume and mortality in non-elderly pneumonia patients stratified by severity: a retrospective cohort study

Authors: Hiraku Kumamaru, Yusuke Tsugawa, Hiromasa Horiguchi, Kanako Kunishima Kumamaru, Hideki Hashimoto, Hideo Yasunaga

Published in: BMC Health Services Research | Issue 1/2014

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Abstract

Background

The characteristics and aetiology of pneumonia in the non-elderly population is distinct from that in the elderly population. While a few studies have reported an inverse association between hospital case volume and clinical outcome in elderly pneumonia patients, the evidence is lacking in a younger population. In addition, the relationship between volume and outcome may be different in severe pneumonia cases than in mild cases. In this context, we tested two hypotheses: 1) non-elderly pneumonia patients treated at hospitals with larger case volume have better clinical outcome compared with those treated at lower case volume hospitals; 2) the volume-outcome relationship differs by the severity of the pneumonia.

Methods

We conducted the study using the Japanese Diagnosis Procedure Combination database. Patients aged 18–64 years discharged from the participating hospitals between July to December 2010 were included. The hospitals were categorized into four groups (very-low, low, medium, high) based on volume quartiles. The association between hospital case volume and in-hospital mortality was evaluated using multivariate logistic regression with generalized estimating equations adjusting for pneumonia severity, patient demographics and comorbidity score, and hospital academic status. We further analyzed the relationship by modified A-DROP pneumonia severity score calculated using the four severity indices: dehydration, low oxygen saturation, orientation disturbance, and decreased systolic blood pressure.

Results

We identified 8,293 cases of pneumonia at 896 hospitals across Japan, with 273 in-hospital deaths (3.3%). In the overall population, no significant association between hospital volume and in-hospital mortality was observed. However, when stratified by pneumonia severity score, higher hospital volume was associated with lower in-hospital mortality at the intermediate severity level (modified A-DROP score = 2) (odds ratio (OR) of very low vs. high: 2.70; 95% confidence interval (CI): 1.12–6.55, OR of low vs. high: 2.40; 95% CI:0.99–5.83). No significant association was observed for other severity strata.

Conclusions

Hospital case volume was inversely associated with in-hospital mortality in non-elderly pneumonia patients with intermediate pneumonia severity. Our result suggests room for potential improvement in the quality of care in hospitals with lower volume, to improve treatment outcomes particularly in patients admitted with intermediate pneumonia severity.
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Literature
1.
Halm EA, Teirstein AS: Clinical practice. Management of community-acquired pneumonia. N Engl J Med. 2002, 347: 2039-2045.CrossRefPubMed
2.
van Gageldonk-Lafeber AB, Bogaerts MA, Verheij RA, van der Sande MA: Time trends in primary-care morbidity, hospitalization and mortality due to pneumonia. Epidemiol Infect. 2009, 137: 1472-1478.CrossRefPubMed
3.
Tang CM, Macfarlane JT: Early management of younger adults dying of community acquired pneumonia. Respir Med. 1993, 87: 289-294.CrossRefPubMed
4.
Lim WS, Baudouin SV, George RC, Hill AT, Jamieson C, Le Jeune I, Macfarlane JT, Read RC, Roberts HJ, Levy ML, Wani M, Woodhead MA: BTS guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax. 2009, 64 (Suppl 3): iii1-iii55.CrossRefPubMed
5.
Simpson JC, Macfarlane JT, Watson J, Woodhead MA: A national confidential enquiry into community acquired pneumonia deaths in young adults in England and Wales. British Thoracic Society Research Committee and Public Health Laboratory Service. Thorax. 2000, 55: 1040-1045.CrossRefPubMedPubMedCentral
6.
Teepe J, Grigoryan L, Verheij TJ: Determinants of community-acquired pneumonia in children and young adults in primary care. Eur Respir J. 2010, 35: 1113-1117.CrossRefPubMed
7.
Yasunaga H, Yanaihara H, Fuji K, Horiguchi H, Hashimoto H, Matsuda S: Impact of hospital volume on postoperative complications and in-hospital mortality after renal surgery: data from the Japanese Diagnosis Procedure Combination Database. Urology. 2010, 76: 548-552.CrossRefPubMed
8.
Sugihara T, Yasunaga H, Horiguchi H, Nishimatsu H, Kume H, Matsuda S, Homma Y: Impact of hospital volume and laser use on postoperative complications and in-hospital mortality in cases of benign prostate hyperplasia. J Urol. 2011, 185 (6): 2248-2253.CrossRefPubMed
9.
Holt PJ, Poloniecki JD, Loftus IM, Thompson MM: Meta-analysis and systematic review of the relationship between hospital volume and outcome following carotid endarterectomy. Eur J Vasc Endovasc Surg. 2007, 33: 645-651.CrossRefPubMed
10.
Carey JS, Robertson JM, Misbach GA, Fisher AL: Relationship of hospital volume to outcome in cardiac surgery programs in California. Am Surg. 2003, 69: 63-68.PubMed
11.
Kuwabara H, Fushimi K, Matsuda S: Relationship between hospital volume and outcomes following primary percutaneous coronary intervention in patients with acute myocardial infarction. Circ J. 2011, 75: 1107-1112.CrossRefPubMed
12.
Vakili BA, Kaplan R, Brown DL: Volume-outcome relation for physicians and hospitals performing angioplasty for acute myocardial infarction in New York state. Circulation. 2001, 104: 2171-2176.CrossRefPubMed
13.
Berman MF, Solomon RA, Mayer SA, Johnston SC, Yung PP: Impact of hospital-related factors on outcome after treatment of cerebral aneurysms. Stroke. 2003, 34: 2200-2207.CrossRefPubMed
14.
Vogel TR, Dombrovskiy VY, Graham AM: Carotid artery stenting in the nation: the influence of hospital and physician volume on outcomes. Vasc Endovascular Surg. 2010, 44: 89-94.CrossRefPubMed
15.
Joynt KE, Orav EJ, Jha AK: The association between hospital volume and processes, outcomes, and costs of care for congestive heart failure. Ann Intern Med. 2011, 154: 94-102.CrossRefPubMedPubMedCentral
16.
Ross JS, Normand SL, Wang Y, Ko DT, Chen J, Drye EE, Keenan PS, Lichtman JH, Bueno H, Schreiner GC, Krumholtz HM: Hospital volume and 30-day mortality for three common medical conditions. New Engl J Med. 2010, 362: 1110-1118.CrossRefPubMedPubMedCentral
17.
Lindenauer PK, Behal R, Murray CK, Nsa W, Houck PM, Bratzler DW: Volume, quality of care, and outcome in pneumonia. Ann Intern Med. 2006, 144: 262-269.CrossRefPubMed
18.
Marrie TJ, Carriere KC, Jin Y, Johnson DH: Mortality during hospitalisation for pneumonia in Alberta, Canada, is associated with physician volume. Eur Respir J. 2003, 22: 148-155.CrossRefPubMed
19.
Thiemann DR, Coresh J, Oetgen WJ, Powe NR: The association between hospital volume and survival after acute myocardial infarction in elderly patients. New Engl J Med. 1999, 340: 1640-1648.CrossRefPubMed
20.
Murata A, Matsuda S, Kuwabara K, Fujino Y, Kubo T, Fujimori K, Horiguchi H: An observational study using a national administrative database to determine the impact of hospital volume on compliance with clinical practice guidelines. Med Care. 2011, 49: 313-320.CrossRefPubMed
21.
22.
Lin HC, Xirasagar S, Chen CH, Hwang YT: Physician’s case volume of intensive care unit pneumonia admissions and in-hospital mortality. Am J Respir Crit Care Med. 2008, 177: 989-994.CrossRefPubMed
23.
Durairaj L, Torner JC, Chrischilles EA, Vaughan Sarrazin MS, Yankey J, Rosenthal GE: Hospital volume-outcome relationships among medical admissions to ICUs. Chest. 2005, 128: 1682-1689.CrossRefPubMed
24.
Houck PM, Bratzler DW, Nsa W, Ma A, Bartlett JG: Timing of antibiotic administration and outcomes for Medicare patients hospitalized with community-acquired pneumonia. Arch Intern Med. 2004, 164: 637-644.CrossRefPubMed
25.
Miyashita N, Matsushima T, Oka M, Japanese Respiratory S: The JRS guidelines for the management of community-acquired pneumonia in adults: an update and new recommendations. Intern Med. 2006, 45: 419-428.CrossRefPubMed
26.
Todo T, Usui M, Takakura K: Treatment of severe intraventricular hemorrhage by intraventricular infusion of urokinase. J Neurosurg. 1991, 74: 81-86.CrossRefPubMed
27.
Ono K, Wada K, Takahara T, Shirotani T: Indications for computed tomography in patients with mild head injury. Neurol Med Chir (Tokyo). 2007, 47: 291-297. discussion 297–298CrossRef
28.
Quan H, Sundararajan V, Halfon P, Fong A, Burnand B, Luthi JC, Saunders LD, Beck CA, Feasby TE, Ghali WA: Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care. 2005, 43: 1130-1139.CrossRefPubMed
29.
Shindo Y, Sato S, Maruyama E, Ohashi T, Ogawa M, Imaizumi K, Hasegawa Y: Comparison of severity scoring systems A-DROP and CURB-65 for community-acquired pneumonia. Respirology. 2008, 13: 731-735.CrossRefPubMed
30.
Hanley JA, Negassa A, Edwardes MD, Forrester JE: Statistical analysis of correlated data using generalized estimating equations: an orientation. Am J Epidemiol. 2003, 157: 364-375.CrossRefPubMed
31.
Peduzzi P, Concato J, Kemper E, Holford TR, Feinstein AR: A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol. 1996, 49: 1373-1379.CrossRefPubMed
32.
Shahin J, Harrison DA, Rowan KM: Relation between volume and outcome for patients with severe sepsis in United Kingdom: retrospective cohort study. BMJ. 2012, 344: e3394.CrossRefPubMedPubMedCentral
33.
Marrie TJ, Carriere KC, Jin Y, Johnson DH: Factors associated with death among adults <55 years of age hospitalized for community-acquired pneumonia. Clin Infect Dis. 2003, 36: 413-421.CrossRefPubMed
34.
Lin HC, Lin CC, Chen CS, Lin HC: Seasonality of pneumonia admissions and its association with climate: an eight-year nationwide population-based study. Chronobiol Int. 2009, 26: 1647-1659.CrossRefPubMed
Metadata
Title
Association between hospital case volume and mortality in non-elderly pneumonia patients stratified by severity: a retrospective cohort study
Authors
Hiraku Kumamaru
Yusuke Tsugawa
Hiromasa Horiguchi
Kanako Kunishima Kumamaru
Hideki Hashimoto
Hideo Yasunaga
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2014
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/1472-6963-14-302

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