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

 Joo Eun Lee  ;  Eun Cheol Park  ;  Suk Yong Jang  ;  Sang Ah Lee  ;  Yoon Soo Choy  ;  Tae Hyun Kim 
 Yonsei Medical Journal, Vol.59(2) : 243-251, 2018 
Journal Title
 Yonsei Medical Journal 
Issue Date
Aged ; 80 and over Aged ; Cohort Studies ; Female ; Heart Failure/diagnosis/*mortality/therapy ; Hospitalization ; High-Volume/statistics & numerical data *Hospitals ; Low-Volume/statistics & numerical data *Hospitals ; Humans ; Male ; Middle Aged ; Patient Readmission/*statistics & numerical data ; Physicians/economics/*supply & distribution ; Proportional Hazards Models ; Quality Improvement ; Health Care/*statistics & numerical data Quality Indicators ; Time Factors ; Treatment Outcome
Readmission ; heart failure ; mortality ; physician volume
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.
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4. Graduate School of Public Health (보건대학원) > Graduate School of Public Health (보건대학원) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Preventive Medicine and Public Health (예방의학교실) > 1. Journal Papers
Yonsei Authors
김태현(Kim, Tae Hyun) ORCID logo https://orcid.org/0000-0003-1053-8958
박은철(Park, Eun-Cheol) ORCID logo https://orcid.org/0000-0002-2306-5398
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