Hostname: page-component-7479d7b7d-t6hkb Total loading time: 0 Render date: 2024-07-11T16:10:05.976Z Has data issue: false hasContentIssue false
  • English
  • Français

Association Between Physician Caseload and Patient Outcome for Sepsis Treatment

Published online by Cambridge University Press:  02 January 2015

Chao-Hung Chen ,
Yi-Hua Chen ,
Hsiu-Chen Lin  and
Herng-Ching Lin
Chao-Hung Chen
Affiliation:
Department of Thoracic Surgery, Mackay Memorial Hospital, Taipei Medical University, Taiwan Mackay Medicine, Nursing, and Management College, Taipei Medical University, Taiwan
Yi-Hua Chen
Affiliation:
Schools of Public Health, Taipei Medical University, Taiwan
Hsiu-Chen Lin
Affiliation:
Department of Pediatric Infection, Taipei Medical University Hospital, Taiwan
Herng-Ching Lin*
Affiliation:
Healthcare Administration, Taipei Medical University, Taiwan
*
School of Health Care Administration, Taipei Medical University, 250 Wu-Hsing St, Taipei 110, Taiwan (henrylllll@tmu.edu.tw)
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

The purpose of this study was to investigate whether physicians with larger sepsis caseloads provide better outcomes, defined as lower in-hospital mortality rates, for patients with sepsis.

Design.

Retrospective cross-sectional study.

Method.

This study used pooled data from the 2002-2004 Taiwan National Health Insurance Research Database. A total of 48,336 patients hospitalized with a principal diagnosis of septicemia were selected and assigned to 1 of 4 caseload groups on the basis of their treating physician's sepsis caseload during the 3 years reflected in the pooled data (low caseload, less than 39 cases; medium caseload, 39–88 cases; high caseload, 89–176 cases; and very high caseload, more than 176 cases). Generalized estimating equation models were used for analysis.

Results.

Receipt of treatment from physicians in the very high, high, and medium caseload groups decreased patients' odds of inhospital mortality by 49% (95% confidence interval [CI], 0.41-0.67; P < .001 ), 40% (95% CI, 0.53-0.68; P < .001 ), and 18% (95% CI, 0.73-0.92; P < .001), respectively, compared with the odds for patients treated by low-caseload physicians. These findings persisted after partitioning out systematic physician-specific and hospital-specific variation and isolating the effects of most hospital, physician, and patient confounders.

Conclusion.

Patients treated by physicians who had a larger sepsis caseload had a substantially lower in-hospital mortality rate than did patients treated by physicians in the other caseload groups, and the difference was statistically significant. This result supports the “practice makes perfect” hypothesis.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 30 , Issue 6 , June 2009 , pp. 556 - 562
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Grossi, P, Gasperina, DD. Antimicrobial treatment of sepsis. Surg Infect (Larchmt) 2006; (suppl 2):S87–91.CrossRefGoogle ScholarPubMed
2.Martin, GS, Mannino, DM, Eaton, S, Moss, M. The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med 2003;348:1546–1554.Google Scholar
3.Lever, A, Mackenzie, I. Sepsis: definition, epidemiology, and diagnosis. BMJ 2007;335:879–883.Google Scholar
4.Strassheim, D, Park, JS, Abraham, E. Sepsis: current concepts in intracellular signaling. Int J Blochem Cell Biol 2002;34:1527–1533.CrossRefGoogle ScholarPubMed
5.Sheikh, K. Utility of provider volume as an indicator of medical care quality and for policy decisions. Am J Med 2001;111:712–715.Google Scholar
6.Hogan, AM, Winter, DC. Does practice make perfect? Ann Surg Oncol 2008;15:1267–1270.Google Scholar
7.Luft, HS, Bunker, JP, Enthoven, AC. Should operations be regionalized? The empirical relation between surgical volume and mortality. N Engl J Med 1979;301:1364–1369.Google Scholar
8.Begg, CB, Cramer, LD, Hoskins, WJ, Brennan, MEImpact of hospital volume on operative mortality for major cancer surgery. JAMA 1998;280:1747–1751.CrossRefGoogle ScholarPubMed
9.Dudley, RA, Johansen, KL, Brand, R, Rennie, DJ, Milstein, A. Selective referral to high-volume hospitals: estimating potentially avoidable deaths. JAMA 2000;283:1159–1166.Google Scholar
10.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.Google Scholar
11.Tu, JV, Austin, PC, Chan, BT. Relationship between annual volume of patients treated by admitting physician and mortality after acute myocardial infarction. JAMA 2001;285:3116–3122.Google Scholar
12.Birkmeyer, JD, Siewers, AE, Finlayson, EV, et al.Hospital volume and surgical mortality in the United States. J Engl J Med 2002;346:1128–1137.Google Scholar
13.Hannan, EL, Racz, M, Ryan, TJ, et al.Coronary angioplasty volume—outcome relationships for hospitals and cardiologists. JAMA 1997;277:892–898.Google Scholar
14.Hardin, JW, Hübe, JM. Generalized Linear Models and Extensions. 2nd ed. College Station, TX: Stata Press; 2007.Google Scholar
15.Elixhauser, A, Steiner, C, Harris, DR, Coffey, RM. Comorbidity measures for use with administrative data. Med Care 1998;36:8–27.Google Scholar
16.Thombs, BD, Singh, VA, Halonen, J, Diallo, A, Milner, SM. The effects of preexisting medical comorbidities on mortality and length of hospital stay in acute burn injury: evidence from a national sample of 31,338 adult patients. Ann Surg 2007;245:629–634.Google Scholar
17.Lin, HC, Lee, HC. Caseload volume-outcome relation for pulmonary embolism treatment: association between physician and hospital caseload volume and 30-day mortality. J Thromb Haemost 2008;6:1707–1712.CrossRefGoogle ScholarPubMed
18.Pan, W. Akaike's information criterion in generalized estimating equations. Biometrics 2001;57:120–125.Google Scholar
19.Hertzer, NR. Outcome assessment in vascular surgery—results mean everything. J Vase Surg 1995;21:6–15.CrossRefGoogle ScholarPubMed
20.Gordon, TA, Burleyson, GP, Tielsch, JM, Cameron, JL. The effects of re-gionalization on cost and outcome for one general high-risk surgical procedure. Ann Surg 1995;221:43–49.Google Scholar
21.Lavernia, CJ, Guzman, JERelationship of surgical volume to short-term mortality, morbidity, and hospital charges in arthroplasty. J Arthroplasty 1995;10:133–140.Google Scholar
22.Peelen, L, de Keizer, NF, Peek, N, Scheffer, GJ, van der Voort, PH, de Jonge, E. The influence of volume and intensive care unit organization on hospital mortality in patients admitted with severe sepsis: a retrospective multicentre cohort study. Crit Care 2007;11:R40.Google Scholar
23.Glance, LG, Li, Y, Osler, TM, Dick, A, Mukamel, DB. Impact of patient volume on the mortality rate of adult intensive care unit patients. Crit Care Med 2006;34:1925–1934.CrossRefGoogle ScholarPubMed
24.Marshall, JC. The staging of sepsis: understanding heterogeneity in treatment efficacy. Crit Care 2005;9:626–628.Google Scholar
25.Lien, YC, Huang, MT, Lin, HC. Association between surgeon and hospital volume and in-hospital fatalities after lung cancer resections: the experience of an Asian country. Ann Thorac Surg 2007;83:1837–1843.Google Scholar
26.Wen, HC, Tang, CH, Lin, HC, Tsai, CS, Chen, CS, Li, CY. Association between surgeon and hospital volume in coronary artery bypass graft surgery outcomes: a population-based study. Ann Thorac Surg 2006;81:835–842.Google Scholar
27.Hannan, EL. The relation between volume and outcome in health care. N Engl J Med 1999;340:1677–1679.CrossRefGoogle ScholarPubMed
28.Sheikh, K. Defining and achieving quality of medical care. Am J Med Qual 1998;13:59–62.Google Scholar
29.Bochud, PY, Bonten, M, Marchetti, O, Calandra, T. Antimicrobial therapy for patients with severe sepsis and septic shock: an evidence-based review. Crit Care Med 2004;32(suppl):S495–512.Google Scholar
30.Vincent, JL, Gerlach, H. Fluid resuscitation in severe sepsis and septic shock: an evidence-based review. Crit Care Med 2004;32(suppl):S451–454.Google Scholar
31.Dellinger, RP, Carlet, JM, Masur, H, et al.Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock. Crit Care Med 2004;32:858–873.Google Scholar
32.Mitka, M. International conference considers health needs of the rural elderly. JAMA 2000;284:423–424.Google Scholar
33.Dellinger, RP, Levy, MM, Carlet, IM, et al.Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock—2008. Crit Care Med 2008;36:296–327.Google Scholar