Hospital resource intensity and cirrhosis mortality in United States
نویسندگان
چکیده
AIM 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. CONCLUSION 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.
منابع مشابه
Personal Mastery and All-Cause Mortality among Older Americans Living with Diabetes
Introduction: Higher personal mastery is associated with better physical functioning, wellbeing, and longevity among older populations. However, few studies have focused on whether personal mastery is protective against mortality among older adults living with diabetes over time. Methods: A total of 1,779 participants were identified from an off-year survey of the Health and Retirement Study....
متن کاملHospital Infection Control accreditation standards: A Comparative Review
Introduction: Nosocomial infection (NI) is an infection occurring in a patient after 48 hours of hospitalization or up to 72 hours after discharge from the hospital, which was not present or incubating at the time of admission. Hospital accreditation standards have a significant impact on the prevention and control of NI. Nevertheless, Iran’s hospital accreditation standards face challenges. T...
متن کاملReview of Natural History, Benefits and Risk Factors Pediatric Liver Transplantation
Liver or hepatic transplantation (LT) is the replacement of a diseased liver with part or whole healthy liver from another person (allograft). Human liver transplants were first performed by Thomas Starzl in the United States and Roy Calne in Cambridge, England in 1963 and 1967, respectively. Liver transplantation is a viable treatment option for end-stage liver disease and acute liver failure....
متن کاملCirrhosis mortality and per capita consumption of distilled spirits, United States, 1949-1994: trend analysis.
OBJECTIVE To describe, evaluate, and suggest interpretations for an observed aggregate-level relation between trends in mortality from cirrhosis and per capita consumption of distilled spirits in the United States. DESIGN Trend analysis using data on US cirrhosis mortality and per capita alcohol consumption. RESULTS There is a consistent long-term trend relation between mortality from cirrh...
متن کاملFactors Associated with Requesting Magnetic Resonance Imaging during the Management of Glomus Tumors
Background: The characteristic clinical presentation of glomus tumors and the low negative predictive value of themagnetic resonance imaging (MRI) raise the question whether MRI improves their management. Therefore, this studyaimed to investigate whether MRI improved the management of glomus tumors.Methods: In total, 87 patients with a histologically confirmed glomus tumor wer...
متن کامل