title: Impact of hospital case volume on quality of end-of-life care in terminal cancer patients.
abstract: BACKGROUND
  Quality of end-of-life (EOL) care is gaining increasing attention. However, the relationship between hospital case volume and performance of benchmark quality indicators is not well characterized. The aim of this study was to determine whether hospital case volume affects EOL care for terminal cancer patients.
  
  
  METHODS
  We conducted a retrospective cross-sectional study using claims data of patients who died of cancer at acute-care hospitals in Kyoto prefecture, Japan, between March 2009 and May 2010. Hospitals were grouped into tertiles based on the number of terminal cancer cases. We used multilevel logistic regression models to examine the association of the following quality indicators with the tertiles: opioid use during the last 2 months of life (indicating good quality of care), provision of intensive care unit (ICU) service or life-sustaining treatments during the last month of life (poor quality), and chemotherapy during the last month of life (poor quality).
  
  
  RESULTS
  The final sample for analysis consisted of 3294 decedents from 88 hospitals. Significant associations between hospital case volume and quality of EOL care were identified after adjusting for patient and hospital characteristics. Small- and medium-volume hospitals were found to be less likely to administer opioids, and medium-volume hospitals were more likely to provide ICU service or life-sustaining treatments when compared with large-volume hospitals. No significant association between chemotherapy use and case volume was observed.
  
  
  CONCLUSIONS
  The results showed that the case volume of terminally ill cancer patients was associated with several aspects of quality of EOL care.
authors.affiliation: Department of Healthcare Economics and Quality Management, Kyoto University Graduate School of Medicine, Yoshida Konoe-cho, Sakyo-ku, Kyoto, Japan.
authors.forename: Toshitaka
authors.initials: T
authors.lastname: Morishima
authors.forename: Jason
authors.initials: J
authors.lastname: Lee
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Otsubo
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ikai
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Imanaka
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000008:administration & dosage; D019985:Benchmarking; D016009:Chi-Square Distribution; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007564:Japan / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D009369:Neoplasms / Q000401:mortality / Q000628:therapy*; D011787:Quality of Health Care; D012189:Retrospective Studies; D013727:Terminal Care / Q000592:standards*
chemical_list: D000701:Analgesics, Opioid