Hospital Volume Outcome and Discharge Disposition of Burn Patients
- 1 April 2006
- journal article
- reconstructive
- Published by Ovid Technologies (Wolters Kluwer Health) in Plastic and Reconstructive Surgery
- Vol. 117 (4), 1296-1305
- https://doi.org/10.1097/01.prs.0000204962.85336.51
Abstract
Background: 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. Methods: 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. Results: 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.” Conclusion: 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.Keywords
This publication has 19 references indexed in Scilit:
- Burn epidemiology: the patient, the nation, the statistics, and the data resourcesCritical Care Nursing Clinics of North America, 2004
- The cost of trauma center readinessThe American Journal of Surgery, 2004
- Hospital volume and surgical outcomes for elderly patients with colorectal cancer in the United StatesJournal of Surgical Research, 2003
- What’s new in general surgery: burns and metabolismJournal of the American College of Surgeons, 2003
- The Volume-Outcome Effect for Abdominal Aortic SurgeryArchives of Surgery, 2002
- Hospital Volume and Surgical Mortality in the United StatesNew England Journal of Medicine, 2002
- Disaster Medicine in the 21st Century: Future Hazards, Vulnerabilities, and RiskPrehospital and Disaster Medicine, 2002
- How Drgs Hurt Academic Health SystemsJournal of the American College of Surgeons, 2001
- Burn Incidence and Medical Care Use in the United States: Estimates, Trends, and Data SourcesJournal of Burn Care & Rehabilitation, 1996
- The Cost of Burn Care and Implications for the Future on Quality of CareJournal Of Trauma-Injury Infection and Critical Care, 1986