Associations of Physician Volume and Weekend Admissions With Ischemic Stroke Outcome in Taiwan

BACKGROUND: Although volume-outcome and weekend-outcome relationships have been explored for various procedures and interventions, limited information is available concerning "physician volume" and the "weekend effect" on stroke mortality. Moreover, little is known about the relative and combined influence of physician and hospital volume on stroke mortality. OBJECTIVES: We used nationwide population-based data to explore the influences of physician volume and weekend admissions on stroke mortality. METHODS: We analyzed all 34,347 ischemic stroke patients admitted in 2005, treated by 2424 physicians practicing in 245 hospitals in Taiwan through Taiwan's National Health Insurance Research Database. Multilevel logistic regression analysis was performed after adjustment for patient, physician, and hospital characteristics to explore the individual and combined impact of annual physician volume and annual hospital volume, as well as the impact of weekend admissions, on 30-day mortality. RESULTS: Higher physician volume, simultaneous contribution of higher physician and higher hospital volume, and weekday admissions were associated with decreased 30-day mortality, after adjusting for patient gender and age, comorbidities, surgery, physician age and specialty, hospital ownership, accreditation level, teaching status, geographic location, regional resources, and competition. CONCLUSIONS: Higher physician volume, rather than higher hospital volume is associated with lower 30-day ischemic stroke mortality, but the relationship has become stronger in higher-volume hospitals. Stroke patients admitted on weekends also have a higher mortality than those admitted on weekdays

Family medicine · Ischemia · Ischemic stroke · MEDLINE · Outcome (game theory) · Political science · Stroke (engine) · Weekend effect · Acute Ischemic Stroke Management · Emergency Medicine · Healthcare Operations and Scheduling Optimization · Hospital Admissions and Outcomes · Internal Medicine · Medicine

• Comparing the mortality risks of nursing professionals with diabetes and general patients with diabetes

  Open Access•Hsiu-Ling Huang, Chuan-Yu Kung et al.•BMC Public Health•2016

  Incluir item

• Do low-income coronary artery bypass surgery patients have equal opportunity to access excellent quality of care and enjoy good outcome in Taiwan

  Open Access•Tsung-Hsien Yu, Tsung‐Hsien Yu et al.•International Journal for Equity…•2014

  Incluir item

• Impact of Cuts in Reimbursement on Outcome of Acute Myocardial Infarction and Use of Percutaneous Coronary Intervention

  Guann-Ming Chang, Simon H Cheng et al.•Medical Care•2011

  Incluir item

• Quality of Care and Patient Outcome in Stroke Units

  Marie Louise Svendsen, Lars Holger Ehlers et al.•Medical Care•2011

  Incluir item

• The Relationships Among Physician and Hospital Volume, Processes, and Outcomes of Care for Acute Myocardial Infarction

  Yu-Chi Tung, Yu‐Chi Tung et al.•Medical Care•2014

  Incluir item

• Do Hospital and Physician Volume Thresholds for the Volume-Outcome Relationship in Heart Failure Exist

  Ying-Yi Chou, Tsung-Hsien Yu et al.•Medical Care•2019

  Incluir item

• The Association of Hospital Volume With Mortality and Costs of Care for Stroke in Japan

  Yusuke Tsugawa, Hiraku Kumamaru et al.•Medical Care•2013

  Incluir item

• Should Operations Be Regionalized?

  Harold S Luft, John P Bunker et al.•New England Journal of Medicine•1979

  Incluir item

• Estimation of the Youden Index and its Associated Cutoff Point

  Open Access•Ronen Fluss, David Faraggi et al.•Biometrical Journal•2005

  Incluir item

• Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases

  Open Access•Richard A Deyo, R DEYO•Journal of Clinical Epidemiology•1992

  Incluir item

• Is Volume Related to Outcome in Health Care? A Systematic Review and Methodologic Critique of the Literature

  Open Access•Ethan A Halm, Clara Lee et al.•Annals of Internal Medicine•2002

  Incluir item

• Efficient Estimation of Average Treatment Effects Using the Estimated Propensity Score

  Open Access•Keisuke Hirano, Guido W Imbens et al.•Econometrica•2003

  Incluir item

• Hierarchical Linear Models

  Marie Davidian•Journal of the American…•2003

  Incluir item

• Hierarchical linear models

  Anthony S Bryk, Stephen W Raudenbush•Hierarchical linear models•2002

  Incluir item

• Quality of Care and Mortality Among Patients With Stroke

  Annette Ingeman, Lars H Pedersen et al.•Medical Care•2008

  Incluir item

• Redirecting Patients to Improve Stroke Outcomes

  Martin Votruba, Mark E Votruba et al.•Medical Care•2006

  Incluir item

• HMO Membership and Patient Age and the Use of Specialty Care for Hospitalized Patients With Acute Stroke

  Maureen A Smith, Eyal Shahar et al.•Medical Care•1999

  Incluir item