Skip Navigation

This Article
Right arrow Full Text Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrowRequest Permissions
Google Scholar
Right arrow Articles by MORSS DY, S.
Right arrow Articles by BASS, E. B.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by MORSS DY, S.
Right arrow Articles by BASS, E. B.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

International Journal for Quality in Health Care 15:139-146 (2003)
© 2003 International Society for Quality in Health Care

Paper

Hospital experience and outcomes for esophageal variceal bleeding

SYDNEY MORSS DY1, DAVID M. CROMWELL2, PAUL J. THULUVATH2 and ERIC B. BASS1,3

Divisions of 1General Internal Medicine
2Gastroenterology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
3Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

Objective. Although higher hospital volume has been associated with better outcomes for many surgical procedures, this relationship does not appear to hold for most common medical diagnoses. We evaluated whether there is a volume–outcome relationship for a rarer and higher-mortality medical diagnosis, esophageal variceal bleeding.

Design. Cross-sectional retrospective study of hospital discharge data.

Setting. All Maryland hospitals from 1992 through 1996.

Study participants. All patients with diagnosis codes for both esophageal variceal bleeding and cirrhosis in relevant diagnosis-related groups.

Main outcome measure. Mortality for esophageal variceal bleeding. We classified hospitals by tertiles of admissions as high (>17 cases of variceal bleeding per year), medium (12–17 cases per year) or low (<12 cases per year) volume.

Results. There were seven high-volume, 13 medium-volume, and 29 low-volume hospitals. Overall in-hospital mortality was 15%. After multiple regression was used to adjust for differences in age, sex, ethnicity, emergency room admission, use of procedures, complexity, Medicaid status, transfer status, and clinical variables associated with mortality from variceal bleeding, there were no significant differences between the high-, medium-, and low-volume hospital groups in in-hospital mortality (16%, 15%, and 13%, respectively). There were also no significant differences in hospital charges ($17 000, $15 000, and $14 000, respectively) or length of stay (8.5, 8.7, and 7.8 days, respectively) between hospital volume groups.

Conclusions. The volume–outcome relationship may not pertain to some medical diseases such as esophageal variceal bleeding. Alternatively, the biases inherent in research using administrative data may make this relationship appear weaker for some medical than for surgical diagnoses in this type of study.

Keywords: administrative data, cirrhosis, end-stage liver disease, esophageal variceal bleeding, hospital volume, mortality, tertiary care


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?




Disclaimer: Please note that abstracts for content published before 1996 were created through digital scanning and may therefore not exactly replicate the text of the original print issues. All efforts have been made to ensure accuracy, but the Publisher will not be held responsible for any remaining inaccuracies. If you require any further clarification, please contact our Customer Services Department.