title: The relationship between physician case volume and in-hospital mortality of critically ill children with a diagnosis of pneumonia: a cross-sectional observational analytical study.
abstract: OBJECTIVE
  The aim of this study is to examine the relationship between physician case volume and the outcomes of critically ill children with pneumonia.
  
  
  METHODS
  This is a population-based cohort study analyzed data provided from by the National Health Insurance Research Database of Taiwan, 2006-2009. Children (aged 3 months to 17 years) having records of intensive care unit (ICU) admission and a diagnosis of pneumonia were included. A total of 9754 critically ill children and 1042 attending physicians were enrolled. The children were assigned to 1 of 4 groups based on the physician's pneumonia case volume.
  
  
  RESULTS
  The patients in the very high case volume group had a significantly lower length of hospital stay, in-hospital mortality rate, and hospitalization expenses, and a significantly higher ratio of ICU to hospital stays than the other 3 groups (P<.001). The probability of death tended to be lower when the physician's case volume was higher. The risk-adjusted odds ratio for in-hospital mortality of very-high case volume group was 0.48 (95% confidence interval, 0.35-0.65; P<.001) compared to low case volume group.
  
  
  CONCLUSIONS
  A higher physician's pneumonia case volume is associated with a lower length of hospital stay, lower in-hospital mortality rate, and lower hospitalization expenses among critically ill children with pneumonia.
authors.affiliation: Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C.; Division of Respiratory Therapy, Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
authors.forename: Yu-Chun
authors.initials: YC
authors.lastname: Chen
authors.affiliation: Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C.; Department of Pediatrics, School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C.; Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.. Electronic address: mjjeng@vghtpe.gov.tw.
authors.forename: Mei-Jy
authors.initials: MJ
authors.lastname: Jeng
authors.affiliation: Department of Pediatrics, School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C.; Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
authors.forename: Yu-Sheng
authors.initials: YS
authors.lastname: Lee
authors.affiliation: Department of Pediatrics, School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C.; Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
authors.forename: Yu-Cheng
authors.initials: YC
authors.lastname: Lo
authors.affiliation: Department of Pediatrics, School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C.; Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
authors.forename: Pei-Chen
authors.initials: PC
authors.lastname: Tsao
authors.affiliation: Department of Pediatrics, School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C.; Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
authors.forename: Chia-Feng
authors.initials: CF
authors.lastname: Yang
authors.affiliation: Department of Pediatrics, School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C.; Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
authors.forename: Wen-Jue
authors.initials: WJ
authors.lastname: Soong
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016638:Critical Illness / Q000401:mortality; D003430:Cross-Sectional Studies; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008505:Medical Staff, Hospital / Q000706:statistics & numerical data*; D016017:Odds Ratio; D011014:Pneumonia / Q000401:mortality*; D013624:Taiwan; D016896:Treatment Outcome; D016526:Workload / Q000706:statistics & numerical data*
keywords: Critically ill children; Outcome; Physician case volume; Pneumonia