Pacella Salvatore J, Butz David A, Comstock Matthew C, Harkins Deborah R, Kuzon William M, Taheri Paul A
Division of Trauma, Burns and Emergency Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI 48109, USA.
Plast Reconstr Surg. 2006 Apr;117(4):1296-305; discussion 1306-7. doi: 10.1097/01.prs.0000204962.85336.51.
The purpose of this investigation was to determine the impact of hospital clinical volume on patient outcomes (i.e., in-hospital mortality, length of stay) and discharge disposition of burn patients using a large nationally representative database.
Patient data were obtained from the 1999-2001 National Inpatient Sample using burn diagnosis-related group codes 504 through 511. Hospitals were segregated into high-volume hospitals (treating more than 100 patients per year), medium-volume hospitals (treating 20 to 99 patients per year), and low-volume hospitals (treating fewer than 20 patients per year). Mortality, length of stay, and discharge disposition were catalogued for each diagnosis-related group code and hospital type.
In diagnosis-related group pair 504/505 (most severe), the mortality rate in patients admitted to high-volume hospitals (33.5 percent) was significantly higher than in patients admitted to both medium-volume hospitals (28.8 percent) and low-volume hospitals (11.5 percent) (p = 0.002). Within lower severity diagnosis-related groups, where the mortality rate was lower across all admissions, medium-volume hospitals and high-volume hospitals had a higher proportion of routine discharges to home, a lower need for home care, and a lower proportion of transfers compared with low-volume hospitals. Despite shorter length of stay, across most burn diagnosis-related groups, patients admitted to low-volume hospitals had lower rates of routine discharges and a higher proportion of admissions "with complications."
Higher-volume facilities, despite receiving the most severe burn patients, may provide better patient outcomes than lower-volume facilities. The patterns of discharges found at lower-volume facilities may result in higher diagnosis-related group reimbursement "capture" by lower-volume facilities and higher postdischarge resource use.
本研究旨在利用一个具有全国代表性的大型数据库，确定医院临床工作量对烧伤患者的治疗结果（即住院死亡率、住院时间）及出院去向的影响。
使用烧伤诊断相关分组代码504至511，从1999 - 2001年全国住院患者样本中获取患者数据。医院被分为高工作量医院（每年治疗超过100例患者）、中等工作量医院（每年治疗20至99例患者）和低工作量医院（每年治疗少于20例患者）。针对每个诊断相关分组代码和医院类型，记录死亡率、住院时间和出院去向。
在诊断相关分组对504/505（最严重）中，高工作量医院收治患者的死亡率（33.5%）显著高于中等工作量医院（28.8%）和低工作量医院（11.5%）（p = 0.002）。在严重程度较低的诊断相关分组中，所有入院患者的死亡率均较低，与低工作量医院相比，中等工作量医院和高工作量医院的常规出院回家比例更高，家庭护理需求更低，转院比例更低。尽管住院时间较短，但在大多数烧伤诊断相关分组中，低工作量医院收治的患者常规出院率较低，“伴有并发症”的入院比例较高。
尽管高工作量医院接收的是最严重的烧伤患者，但与低工作量医院相比，可能能提供更好的治疗结果。低工作量医院的出院模式可能导致低工作量医院获得更高的诊断相关分组报销“收入”，以及出院后更高的资源使用。
