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

Bibliographic Data

ID9098142
AuthorsYusuke Tsugawa (0000-0002-1937-4833, Harvard University Press, corresponding author), Hiraku Kumamaru (0000-0002-9759-6191, Harvard University), Hideo Yasunaga (0000-0002-6017-469X), Hideki Hashimoto (0000-0003-3663-6564, University of Tokyo Health Sciences), Hiromasa Horiguchi (0000-0002-4921-7652), John Z Ayanian (Harvard University)
Year2013
Volume51
Issue9
Pages782-788
Publication date2013-09-01
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueMedical Care (JOURNAL)
Journal identifiersISSN: 0025-7079 • E-ISSN: 1537-1948
PublisherOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/mlr.0b013e31829c8b70
PMID23942219
OpenAlexW2312710518
LanguageEN
Citations received1
References cited11

BACKGROUND: The association between hospital volume and patient outcomes remains unclear for stroke. Little is known about whether these relationships differ by stroke subtypes. OBJECTIVES: To examine the association of hospital volume with in-hospital mortality and costs of care for stroke. RESEARCH DESIGN: Secondary data analysis of national hospital database. SUBJECTS: A total of 66,406 patients admitted between July 1 and December 31, 2010 with primary diagnosis of stroke at 796 acute care hospitals in Japan were included. MEASURES: We used a locally weighted scatter-plot smoothing method to test the relationship between hospital volume and outcomes. On the basis of these results, we categorized patient volume into 3 groups (10-50, 51-100, and >100 discharges/6 mo). We tested the volume-outcome relationship using multivariable regression models adjusting for patient and hospital characteristics. Subgroup analysis was conducted by stratifying on stroke subtype. RESULTS: Compared with those treated at high-volume hospitals (>100 discharges), patients admitted to low-volume hospitals (10-50 discharges) had higher in-hospital mortality (adjusted odds ratio, 1.45; 95% CI, 1.23-1.71, P<0.0001). In the lowest volume hospitals, adjusted costs of care per discharge were 8.0% lower (95% CI, -14.1% to -1.8%, P=0.01) compared with the highest volume hospitals. The volume-mortality association was significant across all stroke subtypes. Highest volume hospitals had higher costs than lowest volume hospitals for subarachnoid hemorrhage, but this association was nonsignificant for ischemic and hemorrhagic stroke. CONCLUSIONS: Highest volume hospitals had lower mortality than the lowest volume hospitals for stroke in Japan. Highest volume hospitals had higher costs for subarachnoid hemorrhage, but not for ischemic and hemorrhagic stroke

Logistic regression · Odds · Odds ratio · Stroke (engine) · Subarachnoid hemorrhage · Acute Ischemic Stroke Management · Emergency Medicine · Internal Medicine · Intracerebral and Subarachnoid Hemorrhage Research · Medicine · Stroke Rehabilitation and Recovery

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