title: Caseload volume-outcome relation for pulmonary embolism treatment: association between physician and hospital caseload volume and 30-day mortality.
abstract: OBJECTIVE
  This study sets out to examine the association between physician and hospital pulmonary embolism (PE) caseload volume and subsequent patient outcomes using 3-year nationwide population-based data in Taiwan.
  
  
  METHODS
  This study used claims data from the 2002-2004 National Health Insurance Research Database. The sample of 2761 PE inpatients was divided into three physician caseload volume groups, <3 cases (low volume), 3-6 cases (medium volume) and >or=7 cases (high volume), while the three hospital volume groups were <42 cases (low volume), 42-110 cases (medium volume) and >or=111 cases (high volume). A conditional logistic regression model was performed to evaluate the effects of caseload volume on 30-day mortality for PE treatment.
  
  
  RESULTS
  Patients treated by low case volume physicians had significantly higher mortality rates than those treated by medium case volume (19.0% vs. 13.3%, P < 0.001) or high case volume physicians (19.0% vs. 8.4%, P < 0.001). However, no significant relationship was observed between 30-day morality and hospital caseload volume (P = 0.697). The regression shows that the adjusted odds of 30-day mortality among patients of low case volume physicians were over twice the mortality odds among patients of high case volume physicians (OR = 2.164, P < 0.001), and odds ratios were 1.401 relative to medium case volume physicians' patients (P < 0.05).
  
  
  CONCLUSIONS
  We conclude that an inverse PE volume-outcome relationship does exist for physicians, but not for hospitals. The skill or experience of an individual physician is a more critical factor than hospital equipment, infrastructure or staffing team in determining PE patient outcomes.
authors.affiliation: School of Health Care Administration, Taipei Medical University Hospital, Taipei, Taiwan. henry11111@tmu.edu.tw
authors.forename: H-C
authors.initials: HC
authors.lastname: Lin
authors.forename: H-C
authors.initials: HC
authors.lastname: Lee
mesh_terms: D017052:Hospital Mortality; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D010043:Outcome and Process Assessment, Health Care; D011655:Pulmonary Embolism / Q000401:mortality / Q000628:therapy*; D013624:Taiwan; D016896:Treatment Outcome; D000078329:Workforce; D016526:Workload