Physician's Case Volume of Intensive Care Unit Pneumonia Admissions and In-Hospital Mortality

Lin, Herng Ching; Xirasagar, Sudha; Chen, Chi-Hung; Hwang, Yi Ting

doi:10.1164/rccm.200706-813oc

Cited by 74 publications

(69 citation statements)

References 20 publications

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“…Our study also confirms the volume-outcome relationship for pneumonia care 6,21 . One possible explanation for the relationship between higher physician volume and better pneumonia outcomes is the "practice makes perfect" hypothesis or a learning effect.…”

Section: Discussionsupporting

confidence: 85%

“…There are some limitations of our study that deserve comment. First, similar to prior studies using administrative databases 6,12,21 , we have no information on clinical details for risk adjustment such as results according to the Pneumonia Severity Index, CURB-65 (confusion, uremia, respiratory rate, low blood pressure, age 65 years or older) or American Thoracic Society/Infectious Disease Society of America (ATS/IDSA) 2007 criteria. However, we adjusted for patient gender, age, case severity and comorbid conditions, which are also important for adjustment of pneumonia complexity.…”

Section: Discussionmentioning

confidence: 99%

“…Patient characteristics included gender, age (<65, 65-74 and >74 years), illness severity and comorbid illness. Patient illness severity is captured in five variables, having an intensive care unit (ICU) admission, respiratory failure/arrest (ICD-9-CM 518.81, 799.1), or hypotension/shock (ICD-9-CM 458, 785.5), and receiving mechanical ventilation (ICD-9-CM 96.7) or inhospital dialysis (ICD-9-CM 39.95, 54.98) 6,20,21 . The Charlson-Deyo index was used to quantify the comorbidities of pneumonia patients 6,22 .…”

Section: Study Variablesmentioning

confidence: 99%

See 2 more Smart Citations

Factors Associated with Pneumonia Outcomes: A Nationwide Population-Based Study over the 1997–2008 Period

Chang

Tung

2011

J GEN INTERN MED

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Study Variablesmentioning

confidence: 99%

See 1 more Smart Citation

Factors Associated with Pneumonia Outcomes: A Nationwide Population-Based Study over the 1997–2008 Period

Chang

Tung

2011

J GEN INTERN MED

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“…Although ED diagnoses in Taiwan are based on the results of a self-administered IIEF-5 questionnaire, the raw scores are not available in the database and we were therefore unable to include any measure for severity in this investigation. Administrative databases are notorious for receiving criticism concerning their diagnostic validity; however, one study by Lin et al 25 has verified the high validity of diagnoses in the Taiwan Health Insurance Database.…”

Section: Resultsmentioning

confidence: 99%

Hyperthyroidism and erectile dysfunction: a population-based case—control study

2012

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Dysthyroidism has been highlighted as a common endocrine disorder associated with erectile dysfunction (ED); however, to date, no large-scale population-based study has investigated the association between hyperthyroidism and ED. This case--control study aimed to explore the association between ED and hyperthyroidism using a population-based data set. In total, 6310 adult patients who received new diagnoses of ED were recruited as cases together with 18 930 matched enrollees with no history of ED who served as controls. Conditional logistic regressions were conducted to explore the association between ED and having been previously diagnosed with hyperthyroidism. In total, 569 (2.3%) of the 25 240 sampled subjects had been diagnosed with hyperthyroidism before the index date; hyperthyroidism was found in 207 (3.3%) cases and 362 (1.90%) controls. After adjusting for potential confounding factors, the odds ratio (OR) of prior hyperthyroidism among cases was 1.64 (95% confidence interval ¼ 1.37--1.96, Po0.001) than that of controls. No association was detected between prior hyperthyroidism and ED for the 18--30, 30--39 and X70 age groups. Subjects aged between 60 and 69 years had the highest ORs for prior hyperthyroidism among cases when compared to controls (OR ¼ 1.84; 95% confidence interval ¼ 1.20--2.84; Po0.001). Our study further confirms the existence of an association between ED and prior hyperthyroidism. INTRODUCTIONHyperthyroidism is a condition in which the thyroid produces an excessive amount of thyroid hormone 1 and affects approximately 2% of women, but significantly less in men. 2 A recently conducted prevalence study in Norway found that 0.9% of all Norwegian men over 20 years old in Nord-Trù ndelag had been diagnosed with hyperthyroidism. 3 Graves' disease accounts for 70% of hyperthyroidism cases, with the age of onset most often occurring during young adulthood 1 and is a genetically linked autoimmune disorder in which the body produces antibodies to its own tissues, which in turn cause the thyroid to produce excess of thyroid hormone. The other 30% of hyperthyroidism cases result from other causes, such as toxic nodular goiters, subacute thyroiditis, exposure to iodine from medications or X-ray dyes and postpartum thyroiditis. Whether on account of autoimmune, inflammatory or metabolic sources, 1 the effects of hyperthyroidism have been reported to be associated with sexual impotence among men. 3,4 Furthermore, one recent study has demonstrated that thyroid hormone nuclear receptors in the penis provide the biological basis for the direct action of thyroid hormones on this organ and suggested that physicians should be advised to investigate sexual function in men with thyroid disorders. 5 Erectile dysfunction (ED) is defined as the inability to achieve or maintain an erection sufficient for satisfactory sexual intercourse and is the most common sexual problem among aging male subjects. 6,7 The Massachusetts Male Aging Study reported that 52% of their community-based survey of men aged between 40...

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“…higher number of patients treated, leads to higher-quality care for a number of conditions (e.g. cancer treatment (Hillner et al (2000)), coronary angioplasty (Jollis et al (1997)), and pneumonia treatment (Lin et al (2008))). Similarly, there is also evidence that higher volume at the hospital level lead to higher-quality care as well (Luft et al (1979), Jollis et al (1997), Hillner et al (2000), Birkmeyer et al (2002), Macias et al (2009)).…”

Section: Literature Reviewmentioning

confidence: 99%

Physician Workload and Hospital Reimbursement: Overworked Physicians Generate Less Revenue per Patient

Powell

Savin

Savva

2012

M&SOM

112

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We study the impact of physician workload on hospital reimbursement utilizing a detailed data set from the trauma department of a major urban hospital. We find that the proportion of patients assigned a "highseverity" status for reimbursement purposes, which maps, on average, to a 47.8% higher payment for the hospital, is substantially reduced as the workload of the discharging physician increases. This effect persists after we control for a number of systematic differences in patient characteristics, condition and time of discharge. Furthermore, we show that it is unlikely to be caused by selection bias or endogeneity in either discharge timing or allocation of discharges to physicians. We attribute this phenomenon to a workloadinduced reduction in diligence of paperwork execution. We estimate the associated monetary loss to be approximately 1.1% (95% Confidence Interval 0.4% − 1.9%) of the department's annual revenue.

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Physician's Case Volume of Intensive Care Unit Pneumonia Admissions and In-Hospital Mortality

Abstract: 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.

Cited by 74 publications

References 20 publications

Factors Associated with Pneumonia Outcomes: A Nationwide Population-Based Study over the 1997–2008 Period

Factors Associated with Pneumonia Outcomes: A Nationwide Population-Based Study over the 1997–2008 Period

Hyperthyroidism and erectile dysfunction: a population-based case—control study

Physician Workload and Hospital Reimbursement: Overworked Physicians Generate Less Revenue per Patient

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