Yonsei Med J.  2018 Mar;59(2):243-251. 10.3349/ymj.2018.59.2.243.

Effects of Physician Volume on Readmission and Mortality in Elderly Patients with Heart Failure: Nationwide Cohort Study

• Lee JE
• Park EC
• Jang SY
• Lee SA
• Choy YS
• Kim TH

• KMID: 2418787
• DOI: http://doi.org/10.3349/ymj.2018.59.2.243

Abstract

PURPOSE
Readmission and mortality rates of patients with heart failure are good indicators of care quality. To determine whether hospital resources are associated with care quality for cardiac patients, we analyzed the effect of number of physicians and the combined effects of number of physicians and beds on 30-day readmission and 1-year mortality.
MATERIALS AND METHODS
We used national cohort sample data of the National Health Insurance Service (NHIS) claims in 2002-2013. Subjects comprised 2345 inpatients (age: >65 years) admitted to acute-care hospitals for heart failure. A multivariate Cox regression was used.
RESULTS
Of the 2345 patients hospitalized with heart failure, 812 inpatients (34.6%) were readmitted within 30 days and 190 (8.1%) had died within a year. Heart-failure patients treated at hospitals with low physician volumes had higher readmission and mortality rates than high physician volumes [30-day readmission: hazard ratio (HR)=1.291, 95% confidence interval (CI)=1.020-1.633; 1-year mortality: HR=2.168, 95% CI=1.415-3.321]. Patients admitted to hospitals with low or middle bed and physician volume had higher 30-day readmission and 1-year mortality rates than those admitted to hospitals with high volume (30-day readmission: HR=2.812, 95% CI=1.561-5.066 for middle-volume beds & low-volume physicians, 1-year mortality: HR=8.638, 95% CI=2.072-36.02 for middle-volume beds & low-volume physicians).
CONCLUSION
Physician volume is related to lower readmission and mortality for heart failure. Of interest, 30-day readmission and 1-year mortality were significantly associated with the combined effects of physician and institution bed volume.

Keyword

Readmission; mortality; heart failure; physician volume

MeSH Terms

Aged
Aged, 80 and over
Cohort Studies
Female
Heart Failure/diagnosis/*mortality/therapy
Hospitalization
*Hospitals, High-Volume/statistics & numerical data
*Hospitals, Low-Volume/statistics & numerical data
Humans
Male
Middle Aged
Patient Readmission/*statistics & numerical data
Physicians/economics/*supply & distribution
Proportional Hazards Models
Quality Improvement
Quality Indicators, Health Care/*statistics & numerical data
Time Factors
Treatment Outcome

Figure

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  Fig. 1 Kaplan-Meier curves of 30-day heart failure all-cause readmission and 1-year mortality according to number of physicians and number of beds.

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  Fig. 2 HR and 95% confidence intervals for 30-day readmission and 1-year mortality associated with combined effects of number of physicians and number of beds: adjusted for patient characteristics and hospital characteristics. *p<0.05. HR, hazard ratio.

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