Volume-outcome relationship on survival and cost benefits in severe burn injury: a retrospective analysis of a Japanese nationwide administrative database

被引:15
作者
Endo, Akira [1 ]
Shiraishi, Atsushi [1 ,2 ]
Otomo, Yasuhiro [1 ]
Fushimi, Kiyohide [3 ]
Murata, Kiyoshi [1 ,4 ]
机构
[1] Tokyo Med & Dent Univ, Hosp Med, Trauma & Acute Crit Care Med Ctr, Bunkyo Ku, 1-5-45 Yushima, Tokyo 1138510, Japan
[2] Kameda Med Ctr, Emergency & Trauma Ctr, 929 Higashicho, Chiba, Japan
[3] Tokyo Med & Dent Univ, Grad Sch Med, Dept Hlth Policy & Informat, Bunkyo Ku, 1-5-45 Yushima, Tokyo, Japan
[4] Matsudo City Gen Hosp, Shock Trauma & Emergency Med Ctr, 933-1 Sendabori, Matsudo, Chiba, Japan
基金
日本学术振兴会;
关键词
Hospital volume; Costs and cost analysis; Mortality; Wounds and injuries; HOSPITAL VOLUME; SENSITIVITY-ANALYSIS; MORTALITY; CARE; EPIDEMIOLOGY; POPULATION; FACILITIES; QUALITY;
D O I
10.1186/s40560-019-0363-7
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
BackgroundAlthough it has been reported that high hospital patient volume results in survival and cost benefits for several diseases, it is uncertain whether this association is applicable in burn care.MethodsWe conducted a retrospective observational study on severe burn patients, defined by a burn index 10, using 2010-2015 data from a Japanese national administrative claim database. A generalized additive mixed-effect model (GAMM) was used to evaluate the nonlinear associations between patient volume and the outcomes (in-hospital mortality, healthcare costs per admission, and hospital-free days at 90days). Generalized linear mixed-effect regression models (GLMMs) in which patient volume was incorporated as a continuous or categorical variable (5 or >5) were also performed. Patient severity was adjusted using the prognostic burn index (PBI) or the risk adjustment model developed in this study, simultaneously controlling for hospital-level clustering. Sensitivity analyses evaluating patients who were directly transported, those with PBI 120 and those excluding patients who died within 2days of admission, were also performed.ResultsWe analyzed 5250 eligible severe burn patients from 737 hospitals. The PBI and the developed risk adjustment model had good discriminative ability with areas under the receiver operating characteristic curves of 0.86 and 0.89, respectively. The GAMM plots showed that in-hospital mortality and healthcare costs increased according to the increase in patient volumes; then, they reached a plateau. Fewer hospital-free days were observed in the higher volume hospitals. The GLMM model showed that patient volume (incorporated as a continuous variable) was significantly associated with increased in-hospital mortality (adjusted odds ratio [95% confidence interval (CI)]=1.14 [1.09-1.19]), high healthcare costs (adjusted difference [95% CI]=$4876 [4436-5316]), and few hospital-free days (adjusted difference [95% CI]=-3.1days [-3.4 to -2.8]). Similar trends were observed in the analyses in which patient volume was incorporated as a categorical variable. The results of sensitivity analyses showed comparable results.ConclusionsAnalysis of Japanese nationwide administrative database demonstrated that high burn patient volume was significantly associated with increased in-hospital mortality, high healthcare costs, and few hospital-free days. Further studies are needed to validate our results.
引用
收藏
页数:11
相关论文
共 38 条
  • [31] The Association of Hospital Volume With Mortality and Costs of Care for Stroke in Japan
    Tsugawa, Yusuke
    Kumamaru, Hiraku
    Yasunaga, Hideo
    Hashimoto, Hideki
    Horiguchi, Hiromasa
    Ayanian, John Z.
    [J]. MEDICAL CARE, 2013, 51 (09) : 782 - 788
  • [32] Sensitivity Analysis in Observational Research: Introducing the E-Value
    VanderWeele, Tyler J.
    Ding, Peng
    [J]. ANNALS OF INTERNAL MEDICINE, 2017, 167 (04) : 268 - +
  • [33] Fast stable restricted maximum likelihood and marginal likelihood estimation of semiparametric generalized linear models
    Wood, Simon N.
    [J]. JOURNAL OF THE ROYAL STATISTICAL SOCIETY SERIES B-STATISTICAL METHODOLOGY, 2011, 73 : 3 - 36
  • [34] Yasuda K, 1986, JPN J BURN INJ, V11, P134
  • [35] Yasunaga H., 2013, ASIAN PAC J DIS MANA, V7, P19
  • [36] Relationship between hospital volume and operative mortality for liver resection: Data from the Japanese Diagnosis Procedure Combination database
    Yasunaga, Hideo
    Horiguchi, Hiromasa
    Matsuda, Shinya
    Fushimi, Kiyohide
    Hashimoto, Hideki
    Ohe, Kazuhiko
    Kokudo, Norihiro
    [J]. HEPATOLOGY RESEARCH, 2012, 42 (11) : 1073 - 1080
  • [37] Impact of hospital volume on hospital mortality, length of stay and total costs after pancreaticoduodenectomy
    Yoshioka, R.
    Yasunaga, H.
    Hasegawa, K.
    Horiguchi, H.
    Fushimi, K.
    Aoki, T.
    Sakamoto, Y.
    Sugawara, Y.
    Kokudo, N.
    [J]. BRITISH JOURNAL OF SURGERY, 2014, 101 (05) : 523 - 529
  • [38] Young P, 2012, CRIT CARE RESUSC, V14, P211