Mortality Linked to Hospital Volume in Acute Conditions

For heart attack, heart failure and pneumonia, higher volume means lower mortality - up to a point
By Jeff Muise
HealthDay Reporter

WEDNESDAY, March 24 (HealthDay News) -- Mortality for acute myocardial infarction, heart failure, and pneumonia is generally reduced in hospitals that handle more patients with those conditions, but there is a point of diminishing returns, according to research published in the March 25 issue of the New England Journal of Medicine.

Joseph S. Ross, M.D., of the Mount Sinai School of Medicine in New York City, and colleagues analyzed Medicare claims for fee-for-service beneficiaries hospitalized from 2004 to 2006 for heart failure, myocardial infarction, or pneumonia. The researchers correlated the odds for death within 30 days against 100-patient incremental increases in hospital volume (adjusted for patient risk and hospital characteristics), and determined volume thresholds above which mortality no longer was reduced.

The researchers found that 30-day mortality for all three conditions decreased as hospital volume increased, but the effect gradually attenuated until condition-specific thresholds were reached. The effect was no longer significant beyond volumes of 610 patients for myocardial infarction, 500 patients for heart failure, and 210 patients for pneumonia.

"Despite this association between hospital volume and mortality, we observed heterogeneity among the hospitals. Many patients who were admitted to low-volume hospitals had excellent outcomes, whereas many other patients who were admitted to high-volume hospitals had poor outcomes. For medical conditions, volume alone does not appear to be a proxy for hospital outcome," the authors write.

Several study authors reported receiving consulting fees from various health plans, as well as consulting fees and research grants from pharmaceutical companies.

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