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.
Ann Arbor, Mich.
From the Section of Plastic Surgery and the Division of Trauma, Burns and Emergency Surgery, Department of Surgery, University of Michigan Health System.
Received for publication January 12, 2005; revised February 13, 2005.
Poster presented at Plastic Surgery 2004, the 73rd Annual Scientific Meeting of the American Society of Plastic Surgeons, in Philadelphia, Pennsylvania, October 10, 2004.
Salvatore J. Pacella, M.D., M.B.A., Section of Plastic Surgery, University of Michigan Health System, 2130 Taubman Center, 1500 East Medical Center Drive, Ann Arbor, Mich. 48109, firstname.lastname@example.org