Hospital volume and patient outcomes in pulmonary embolism

Aujesky, Drahomir; Mor, Maria K.; Ming Geng; Fine, Michael J.; Renaud, Bertrand; Ibrahim, Said A.
January 2008
CMAJ: Canadian Medical Association Journal;1/1/2008, Vol. 178 Issue 1, p27
Academic Journal
Background: In numerous high-risk medical and surgical conditions, a greater volume of patients undergoing treatment in a given setting or facility is associated with better survival. For patients with pulmonary embolism, the relation between the number of patients treated in a hospital (volume) and patient outcome is unknown. Methods: We studied discharge records from 186 acute care hospitals in Pennsylvania for a total of 15 531 patients for whom the primary diagnosis was pulmonary embolism. The study outcomes were all-cause mortality in hospital and within 30 days after presentation for pulmonary embolism and the length of hospital stay. We used logistic models to study the association between hospital volume and 30-day mortality and discrete survival models to study the association between in-hospital mortality and time to hospital discharge. Results: The median annual hospital volume for pulmonary embolism was 20 patients (interquartile range 10.42). Overall in-hospital mortality was 6.0%, whereas 30-day mortality was 9.3%. In multivariable analysis, very-high-volume hospitals (. 42 cases per year) had a significantly lower odds of in-hospital death (odds ratio [OR] 0.71, 95% confidence interval [CI] and of 30-day death (OR 0.71, 95% CI than very-low-volume hospitals (< 10 cases per year). Although patients in the very-high- volume hospitals had a slightly longer length of stay than those in the very-low-volume hospitals (mean difference 0.7 days), there was no association between volume and length of stay. Interpretation: In hospitals with a high volume of cases, pulmonary embolism was associated with lower short-term mortality. Further research is required to determine the causes of the relation between volume and outcome for patients with pulmonary embolism.


Related Articles

  • A systematic review of the magnitude and cause of geographic variation in unplanned hospital admission rates and length of stay for ambulatory care sensitive conditions. Busby, John; Purdy, Sarah; Hollingworth, William // BMC Health Services Research;Aug2015, Vol. 15 Issue 1, p1 

    Background: Unplanned hospital admissions place a large and increasing strain on healthcare budgets worldwide. Many admissions for ambulatory care sensitive conditions (ACSCs) are thought to be preventable, a belief supported by significant geographic variations in admission rates. We conducted...

  • Incidence and Outcome of Hospital-treated Head Injury in Rhode Island. Fife, Daniel; Faich, Gerald; Hollinshead, William; Boynton, Wentworth // American Journal of Public Health;Jul1986, Vol. 76 Issue 7, p773 

    Abstract: Hospital discharge summary data were used to identify and study all 2,870 Rhode Island residents hospitalized in-state with head injuries during 1979 and 1980. The overall hospitalized incidence rate was 152 per 100,000 of population per year with age and sex variations similar to...

  • Shorter hospital stay after pulmonary embolism related to postdischarge mortality.  // Hem/Onc Today;5/25/2008, Vol. 9 Issue 9, p24 

    The article discusses a study which determined the effect of patient and hospital factors on length of hospital stay in patients with pulmonary embolism in Pennsylvania, which was presented in the "Archives of Internal Medicine." Results showed that patients hospitalized whose length of stay was...

  • Decision support for hospital bed management using adaptable individual length of stay estimations and shared resources. Schmidt, Robert; Geisler, Sandra; Spreckelsen, Cord // BMC Medical Informatics & Decision Making;2013, Vol. 13 Issue 1, p1 

    Background: Elective patient admission and assignment planning is an important task of the strategic and operational management of a hospital and early on became a central topic of clinical operations research. The management of hospital beds is an important subtask. Various approaches have been...

  • Number of Discharges and Average Length of Stay at Short-Stay Hospitals for Mental Illness, 1990-2002.  // hfm (Healthcare Financial Management);Feb2005, Vol. 59 Issue 2, p27 

    This article presents a graphical representation of the number of discharges and average length of stay at short-stay hospitals for mental illness during 1990-2002 in the U.S.

  • Wasted Hospital Days Impair the Value of Length-of-Stay Variables in the Quality Assessment of Trauma Care. JACOBS, DAVID G.; SARAFIN, JENNIFER L.; NORTON, H. JAMES; CHRISTMAS, A. BRITT; HUYNH, TOAN; SING, RONALD F. // American Surgeon;Sep2009, Vol. 75 Issue 9, p794 

    Hospital length of stay (LOS) is frequently used to evaluate the quality of trauma care but LOS may be impacted by nonmedical factors as well. We reviewed our experience with delays in patient discharge to determine its financial consequences and its impact on LOS. We performed an analysis of...

  • An Evaluation of a Hospital Stay Regulatory Mechanism. Lave, Judith R.; Leinhardt, Samuel // American Journal of Public Health;Oct76, Vol. 66 Issue 10, p959 

    The results of an evaluation of a pre-discharge utilization review program [PDUR] for Medicaid Patients are presented. A group of hospitals in Allegheny County, Pennsylvania, participated in this program on a voluntary basis prior to the program's being mandated statewide. All other hospitals in...

  • Short Hospital Stays for Mothers and Newborns. Braveman, Paula A. // Journal of Family Practice;May96, Vol. 42 Issue 5, p523 

    The article considers the application of short hospital stays for mothers and newborns in the U.S. During the 1970s, the routine length of hospital stay for mothers and newborns began to decline in response to public demand to de-medicalize childbirth and provide women and families with more...

  • Medicare Short-Stay Hospital Utilization Trends: CYs 1972-92.  // Health Care Financing Review;Summer94 Supplement, Vol. 15, p48 

    The article provides information on Medicare short-stay hospital (SSH) utilization trends from 1972 to 1992. The measurement of SSH utilization trends is based on the annual total days of care (TDOC) rate per 1,000 enrollees, which is the product of the annual discharge rate per 1,000 enrollees...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics