title: Mortality during hospitalisation for pneumonia in Alberta, Canada, is associated with physician volume.
abstract: The association of mortality with patient factors (severity of illness, comorbidity), physician factors (specialty training, prehospitalisation visit, in-hospital consultation, volume of patients seen per physician) and healthcare organisation factors (patient-travel distances, regional beds per capita, admitting hospital-bed occupancy, admitting hospital-bed turnover, hospital location, volume of pneumonia cases per hospital) after hospital admission with community-acquired pneumonia was investigated using administrative data from Alberta, Canada from April 1, 1994-March 31, 1999. During the 5-yr study period there were 43,642 pneumonia hospitalisations, with an 11% in-hospital and 26% 1-yr mortality. Patient severity of illness and comorbidity were the strongest predictors of increased mortality. Physicians with the highest in-hospital pneumonia patient volume (>27 patients x yr(-1)) cared for patients with greater severity/comorbidity, but with decreased odds of in-hospital mortality, compared with the lowest volume physicians (less than seven patients per year). The effects of internal medicine specialist or subspecialist care were mixed, with a reduction in deaths for the first 72 h and an increase in in-hospital deaths. Prehospitalisation visit by a physician was associated with decreased mortality. Healthcare organisation factors were the least strong predictor of mortality, demonstrating an effect only for 1-yr mortality in those discharged alive from hospital. Admissions to larger volume or metropolitan hospitals were associated with a decrease in mortality. Severity of illness and comorbidity had the strongest association with mortality. The first association of high-volume physician and pre-hospital care with decreased in-hospital mortality for community-acquired pneumonia is reported.
authors.affiliation: Dept of Medicine, University of Alberta, Alberta, Canada.
authors.forename: T J
authors.initials: TJ
authors.lastname: Marrie
authors.forename: K C
authors.initials: KC
authors.lastname: Carriere
authors.forename: Y
authors.initials: Y
authors.lastname: Jin
authors.forename: D H
authors.initials: DH
authors.lastname: Johnson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000416:Alberta / Q000453:epidemiology; D017714:Community-Acquired Infections / Q000401:mortality*; D015897:Comorbidity; D005163:Factor Analysis, Statistical; D005260:Female; D006302:Health Services Research; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008511:Medicine; D008875:Middle Aged; D010820:Physicians / Q000592:standards*; D011014:Pneumonia / Q000401:mortality*; D012307:Risk Factors; D012720:Severity of Illness Index; D013038:Specialization