| Lin HC |
------>authors3_c= ------>paper_class1=1 ------>Impact_Factor=9.074 ------>paper_class3=2 ------>paper_class2=1 ------>vol=177 ------>confirm_bywho=nwkuo ------>insert_bywho=henry11111 ------>Jurnal_Rank=2.9 ------>authors4_c= ------>comm_author=1 ------>patent_EDate=None ------>authors5_c= ------>publish_day=1 ------>paper_class2Letter=None ------>page2=994 ------>medlineContent= ------>unit=E0800 ------>insert_date=20080128 ------>iam=1 ------>update_date=None ------>author=??? ------>change_event=4 ------>ISSN= ------>authors_c= ------>score=366 ------>journal_name=American Journal of Respiratory and Critical Care Medicine ------>paper_name=Physician's Case Volume of ICU Pneumonia Admissions and In-hospital Mortality ------>confirm_date=20080713 ------>tch_id=090053 ------>pmid=18263804 ------>page1=989 ------>fullAbstract=RATIONALE: Although several studies have investigated volume-outcome relationships for surgical procedures, there has been no such study of intensive care unit (ICU) patients admitted for pneumonia. OBJECTIVES: This study examines associations between in-hospital mortality of ICU-admitted pneumonia patients and their attending physician~s case volume. METHODS: We used 2002-2004 claims data from Taiwan~s National Health Insurance for all 87,479 adult ICU admissions for pneumonia. Patients were assigned to one of four groups, on the basis of their physician~s ICU pneumonia case volume (low volume, <36 cases; medium volume, 37-114 cases; high volume, 118-314 cases; and very high volume, > or =315 cases). Generalized estimating equations (conditional on hospital, and unconditional) were used, adjusting for physician demographics and specialty, hospital characteristics, patient characteristics (including clinical severity and comorbidities), and physician-level random effect (clustering effect) to assess whether physicians~ case volume predicts in-hospital mortality. MEASUREMENTS AND MAIN RESULTS: In-hospital mortality systematically declined with increasing physician case volume: 14.7, 14.3, 11.4, and 8.1% from low-volume to very-high-volume groups. Adjusted unconditional odds of mortality among low-volume physicians~ patients were 2.04 times those of very-high-volume physicians, 1.35 times that of high-volume physicians, and 1.09 times those of medium-volume physicians (all P < 0.001). The relationship is sustained when the odds are estimated conditional on hospital, when initial 5-day mortality is separated from 30-day mortality, and when pulmonologists~ and critical care specialists~ patients are studied separately. CONCLUSIONS: Physician volume significantly predicts inpatient mortality among ICU patients with pneumonia. Detailed study of clinical approaches, decision algorithms, and treatment plans of high-volume physicians is recommended to identify possible mediating factors in this phenomenon. ------>tmu_sno=None ------>sno=16629 ------>authors2=Xirasagar S ------>authors3=Chen CH ------>authors4=Hwang YT ------>authors5= ------>authors6= ------>authors6_c= ------>authors=Lin HC ------>delete_flag=0 ------>SCI_JNo=None ------>authors2_c= ------>publish_area=0 ------>updateTitle=Physician~s case volume of intensive care unit pneumonia admissions and in-hospital mortality. ------>language=2 ------>check_flag=None ------>submit_date=None ------>country=None ------>no=9 ------>patent_SDate=None ------>update_bywho=None ------>publish_year=2008 ------>submit_flag=None ------>publish_month=1 |