Clinical research studiesAssociation between physician specialty and volumes of treated patients and mortality among patients hospitalized for newly diagnosed heart failure
Section snippets
Methods
The analysis was done within the protected environment of Alberta Health and Wellness and was governed by section 27 of the Alberta Health Information Act on the use of health data in the custodial care of the provincial government. This study was exempted from informed patient consent or ethical board review by meeting the requirement for physician practice surveillance and quality assurance.
For this study we used the following administrative data sources: Canadian Institute for Health
Results
During the 6 years of the study, the 16,162 patients who had acute care hospital discharges for newly diagnosed heart failure constituted 50% of the 32,139 total admissions for heart failure. In-hospital mortality for newly diagnosed heart failure was 9%, and overall 1-year mortality was 23%. The median number of heart failure patients per unique most responsible physician was 34. General practice physicians without a specialist/subspecialist consultation treated 46% of patients, general
Discussion
We found that hospital management of heart failure patients by high-volume physicians was associated with improved in-hospital survival. After adjusting for hospital volume and comorbid conditions, the odds of in-hospital mortality among heart failure patients decreased with volume of patients treated. This association persisted even after accounting for physician specialty. However, the mortality benefits of high-volume physician care during actual hospitalization did not persist at 1 year.
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Cited by (13)
Determinants of early readmission after hospitalization for heart failure
2014, Canadian Journal of CardiologyCitation Excerpt :Those transferred in from other facilities may have been more likely to live in rural settings with less access to outpatient follow-up or specialty HF services after hospitalization, as described in other studies.25,26 Using 1994-2000 Alberta administrative data, Cujec et al. reported that patients with HF cared for by primary care physicians were less likely to be readmitted within 180 days after discharge (adjusted odds ratio [aOR], 0.81; 95% confidence interval [CI], 0.71-0.92) compared with specialist-treated patients.27 Our more recent data show that although specialty of the attending physician was not associated with readmission risk after adjustment for comorbidity burdens and patient demographics, patients discharged from hospitals with specialized HF services were at lower risk for readmission regardless of duration of observation (ie, 7 days and 30 days) or reason for readmission (ie, all causes or HF).
Predictors of hospital length of stay in heart failure: Findings from get with the guidelines
2011, Journal of Cardiac FailureCitation Excerpt :Hospital volume is now considered a surrogate of quality and has been incorporated into hospital referral criteria for high-risk procedures.9,10 When volume per provider was previously evaluated, inpatient mortality decreased by 4% for each 10 additional HF patients cared for by a provider (OR = 0.96; 95% CI: 0.95 to 0.98); there was, however, no significant difference in LOS, readmission rate, or long-term (1 year) survival by volume quartile.11 As noted in this study and a previous analysis of 36,078 patients enrolled in the GWTG-HF program,12 longer LOS did correlate with a greater percentage of overall core quality measures being achieved.
Bayesian gamma frailty proportional hazard model using spline for hazard function
2017, International Journal of Agricultural and Statistical Sciences
This work was partially supported by the Alberta Center for Health Service Utilization Research. The opinions and conclusions expressed in this paper are those of the authors, and no endorsement by the Alberta Ministry of Health & Wellness is implied.