title: Hospital resource intensity and cirrhosis mortality in United States.
abstract: OBJECTIVE
  To determine whether hospital characteristics predict cirrhosis mortality and how much variation in mortality is attributable to hospital differences.
  
  
  METHODS
  We used data from the 2005-2011 Nationwide Inpatient Sample and the American Hospital Association Annual survey to identify hospitalizations for decompensated cirrhosis and corresponding facility characteristics. We created hospital-specific risk and reliability-adjusted odds ratios for cirrhosis mortality, and evaluated patient and facility differences based on hospital performance quintiles. We used hierarchical regression models to determine the effect of these factors on mortality.
  
  
  RESULTS
  Seventy-two thousand seven hundred and thirty-three cirrhosis admissions were evaluated in 805 hospitals. Hospital mean cirrhosis annual case volume was 90.4 (range 25-828). Overall hospital cirrhosis mortality rate was 8.00%. Hospital-adjusted odds ratios (aOR) for mortality ranged from 0.48 to 1.89. Patient characteristics varied significantly by hospital aOR for mortality. Length of stay averaged 6.0 ± 1.6 days, and varied significantly by hospital performance (P< 0.001). Facility level predictors of risk-adjusted mortality were higher Medicaid case-mix (OR = 1.00,P= 0.029) and LPN staffing (OR = 1.02,P= 0.015). Higher cirrhosis volume (OR = 0.99,P= 0.025) and liver transplant program status (OR = 0.83,P= 0.026) were significantly associated with survival. After adjusting for patient differences, era, and clustering effects, 15.3% of variation between hospitals was attributable to differences in facility characteristics.
  
  
  CONCLUSIONS
  Hospital characteristics account for a significant proportion of variation in cirrhosis mortality. These findings have several implications for patients, providers, and health care delivery in liver disease care and inpatient health care design.
authors.affiliation: Amit K Mathur, Ryan Day, Andrew L Singer, Winston R Hewitt, Kunam S Reddy, Adyr A Moss, Division of Transplant Surgery, Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ 85054, United States.
authors.forename: Amit K
authors.initials: AK
authors.lastname: Mathur
authors.affiliation: Amit K Mathur, Ryan Day, Andrew L Singer, Winston R Hewitt, Kunam S Reddy, Adyr A Moss, Division of Transplant Surgery, Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ 85054, United States.
authors.forename: Apurba K
authors.initials: AK
authors.lastname: Chakrabarti
authors.affiliation: Amit K Mathur, Ryan Day, Andrew L Singer, Winston R Hewitt, Kunam S Reddy, Adyr A Moss, Division of Transplant Surgery, Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ 85054, United States.
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Mellinger
authors.affiliation: Amit K Mathur, Ryan Day, Andrew L Singer, Winston R Hewitt, Kunam S Reddy, Adyr A Moss, Division of Transplant Surgery, Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ 85054, United States.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Volk
authors.affiliation: Amit K Mathur, Ryan Day, Andrew L Singer, Winston R Hewitt, Kunam S Reddy, Adyr A Moss, Division of Transplant Surgery, Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ 85054, United States.
authors.forename: Ryan
authors.initials: R
authors.lastname: Day
authors.affiliation: Amit K Mathur, Ryan Day, Andrew L Singer, Winston R Hewitt, Kunam S Reddy, Adyr A Moss, Division of Transplant Surgery, Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ 85054, United States.
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Singer
authors.affiliation: Amit K Mathur, Ryan Day, Andrew L Singer, Winston R Hewitt, Kunam S Reddy, Adyr A Moss, Division of Transplant Surgery, Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ 85054, United States.
authors.forename: Winston R
authors.initials: WR
authors.lastname: Hewitt
authors.affiliation: Amit K Mathur, Ryan Day, Andrew L Singer, Winston R Hewitt, Kunam S Reddy, Adyr A Moss, Division of Transplant Surgery, Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ 85054, United States.
authors.forename: Kunam S
authors.initials: KS
authors.lastname: Reddy
authors.affiliation: Amit K Mathur, Ryan Day, Andrew L Singer, Winston R Hewitt, Kunam S Reddy, Adyr A Moss, Division of Transplant Surgery, Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ 85054, United States.
authors.forename: Adyr A
authors.initials: AA
authors.lastname: Moss
mesh_terms: D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D006295:Health Resources / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D007297:Inpatients; D007902:Length of Stay; D008103:Liver Cirrhosis / Q000401:mortality* / Q000601:surgery; D016031:Liver Transplantation / Q000706:statistics & numerical data; D016017:Odds Ratio; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
keywords: Cirrhosis; Hospital variation; Mortality; Outcomes; Quality; Resource utilization