Practice makes perfect: a volume-outcome study of hospital patients with HIV disease.
ABSTRACT There is considerable evidence that patients with HIV fare better in hospitals that treat more HIV-positive patients. Yet, it is possible that much of this benefit is attributable to the care provided by physicians who treat high volumes of HIV-positive patients. This study examines the relation between 2 measures of volume (the number of HIV-positive patients treated in a hospital and the number of HIV-positive patients treated by the attending physician) and the probability of dying in the hospital.
This study uses discharge data from 43,325 patients hospitalized with HIV disease in 5 states (Colorado, Maryland, New Jersey, New York, and Washington State) in 2002. These data were obtained from the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project State Inpatient Databases.
Volume-outcome studies have demonstrated an inverse relation between the number of HIV-positive patients treated at a hospital and the mortality rate for these patients. Yet, the most current of these studies is based on data more than a decade old, and none of these account for the volume of HIV-positive patients treated by the physician. This study uses multivariate logistic regression analyses to estimate the impact of hospital and physician volume on patient mortality.
This study found that when measures of physician and hospital volume are included in a regression equation explaining patient mortality, only the variable measuring physician volume remains statistically significant. Moreover, when a variable is defined for each patient based on the quartile rankings of the patient's hospital volume and the patient's physician volume, the quartile ranking of physician volume is a better predictor of survival than the quartile ranking of hospital volume.
These findings suggest that the volume of patients treated by the attending physician is the key measure of volume associated with the survival of hospitalized HIV-positive patients.
- SourceAvailable from: John A Howington
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- "physician volume as the number of surgeries done over a specific time period and used that measure to predict outcomes of each surgery performed within that same time period     . As a result, experience not yet acquired was used to describe current performance, which could potentially overestimate the influence of volume on surgeon outcomes. "
ABSTRACT: This study examined the effect of surgeons' volume on outcomes in lung surgery: lobectomies and wedge resections. Additionally, the effect of video-assisted thoracoscopic surgery (VATS) on cost, utilization, and adverse events was analyzed. The Premier Hospital Database was the data source for this analysis. Eligible patients were those of any age undergoing lobectomy or wedge resection using VATS for cancer treatment. Volume was represented by the aggregate experience level of the surgeon in a six-month window before each surgery. A positive volume-outcome relationship was found with some notable features. The relationship is stronger for cost and utilization outcomes than for adverse events; for thoracic surgeons as opposed to other surgeons; for VATS lobectomies rather than VATS wedge resections. While there was a reduction in cost and resource utilization with greater experience in VATS, these outcomes were not associated with greater experience in open procedures.Minimally Invasive Surgery 11/2012; 2012:760292. DOI:10.1155/2012/760292
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ABSTRACT: In a rapidly aging society, inappropriately long geropsychiatric inpatient hospitalization is a challenging concern for mental health policy-makers and researchers. This study aimed to investigate patient and institutional factors affecting geropsychiatric inpatient length of stay (LOS), providing an overview of current geropsychiatric health care system in South Korea. This retrospective, population-based, cross-sectional study analysed nationwide reimbursement claim databases covering the entire elderly population of Korea between January 2005 and June 2006. Given the nested structure of the data, a multivariate multilevel regression analysis was performed. The average LOS was 128 days. Males, patients with schizophrenia, and those enrolled in a National Medical Care Aid program tended to have longer hospital stays. Patient age was negatively related to LOS. Institutional variables related to longer hospitalizations included a psychiatric hospital, a higher number of beds, fewer human resource employees, a higher proportion of male, oldest old, and patients with dementia. Our results suggest that policies targeting geropsychiatric patients diagnosed with schizophrenia, enrolled in National Medical Care Aid programs, and admitted to psychiatric hospitals could reduce LOS. Additionally, the impact of the patient composition of a medical institution on LOS needs to be closely investigated.Health Policy 09/2009; 94(2):120-8. DOI:10.1016/j.healthpol.2009.09.004 · 1.91 Impact Factor
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ABSTRACT: As artistry has been refined in body contouring surgery, streamlining wound closure is the next advance on the horizon. Absorbable barbed suture is one potential solution. The authors present their experience with this suture in wound closure for different body regions. A review of operative and clinic notes of 496 patients who had body contouring procedures from March of 1998 to September of 2008 was performed. Variables studied included age, gender, body mass index, medical history, and operative data. Use of barbed suture was noted, and complications were tabulated. Multilevel analysis was performed using generalized estimate equation method. The records of 910 operations in 496 patients were analyzed. Procedures were performed on multiple body regions: abdomen (n=493), chest (n=124), back (n=104), thigh (n=104), and arm (n=88). Barbed suture was used in 114 cases. There were 115 wound-healing problems, with barbed suture present in 17 cases. On unadjusted analysis, the wound complication rate with barbed suture was 17.5 percent, compared with 12.0 percent when barbed suture was not used (p=0.093). On multilevel multivariable analysis, age (odds ratio, 1.04) and body mass index at contour (odds ratio, 1.05) were significant in impairing wound healing (p<0.01), and barbed suture was not associated with the wound complication rate. In subset analysis, barbed suture was associated with significantly higher wound complication rate in the arm (odds ratio, 8.4; p=0.046). Barbed suture presents problems with wound healing, particularly in the arm. The authors look forward to seeing the evolution in technologies designed to improve the speed and outcome of wound closure for lengthy body contouring procedures.Plastic and Reconstructive Surgery 11/2010; 126(5):1735-41. DOI:10.1097/PRS.0b013e3181ef8fa3 · 2.99 Impact Factor