Patients admitted to high-volume hospitals for specific conditions are less likely to die, but a threshold volume exists.
Previous studies on surgical and medical procedures have shown that higher hospital volumes for specific procedures translate to lower mortality. Whether this observation holds true for acute medical illnesses is less clear.
Investigators examined Medicare data for patients who were hospitalized from 2004 through 2006 with diagnoses of acute myocardial infarction, pneumonia, or heart failure. Using the number of annual admissions for these conditions, hospitals were classified as large-, medium- or small-volume for each condition. The investigators analyzed the association between all-cause 30-day mortality and hospital volume for each condition and calculated the volume threshold, above which mortality for each condition no longer improved significantly.
Higher hospital volume was associated with lower 30-day mortality for patients hospitalized for all three conditions: acute myocardial infarction (odds ratio, 0.89), heart failure (OR, 0.91), and pneumonia (OR, 0.95). The volume effect was greatest in small-volume hospitals and was least in large-volume hospitals. Investigators also determined annual volume thresholds above which 100 additional patients were no longer associated significantly with lower odds of death: 610 for patients with acute myocardial infarction, 500 for patients with heart failure, and 210 for patients with pneumonia. In a subgroup analysis of teaching hospitals, these thresholds were significantly lower: 260, 148, and 37, respectively.
Comment: This study demonstrates that patients with acute myocardial infarction, heart failure, or pneumonia might have lower risk for death if they receive care at hospitals that handle higher volumes of such patients. This finding could be due to standardized care protocols or disease-specific management programs that have been implemented at these centers. How policymakers might use these data to increase volume at smaller hospitals is less clear. Although regionalization for elective surgical procedures might be practical, regionalization of care for acute medical conditions would not be feasible.
— Grace C. Huang, MD
Published in Journal Watch Hospital Medicine May 10, 2010
Source : http://hospital-medicine.jwatch.org/cgi/content/full/2010/510/1?q=etoc_jwem
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