Hospital volume outcome and discharge disposition of burn patients.

Abstract

The purpose of this investigation was to determine the impact of hospital clinical volume on patient outcomes (i.e., in-hospital mortality, length of stay) and discharge disposition of burn patients using a large nationally representative database. Patient data were obtained from the 1999-2001 National Inpatient Sample using burn diagnosis-related group codes 504 through 511. Hospitals were segregated into high-volume hospitals (treating more than 100 patients per year), medium-volume hospitals (treating 20 to 99 patients per year), and low-volume hospitals (treating fewer than 20 patients per year). Mortality, length of stay, and discharge disposition were catalogued for each diagnosis-related group code and hospital type. In diagnosis-related group pair 504/505 (most severe), the mortality rate in patients admitted to high-volume hospitals (33.5 percent) was significantly higher than in patients admitted to both medium-volume hospitals (28.8 percent) and low-volume hospitals (11.5 percent) (p = 0.002). Within lower severity diagnosis-related groups, where the mortality rate was lower across all admissions, medium-volume hospitals and high-volume hospitals had a higher proportion of routine discharges to home, a lower need for home care, and a lower proportion of transfers compared with low-volume hospitals. Despite shorter length of stay, across most burn diagnosis-related groups, patients admitted to low-volume hospitals had lower rates of routine discharges and a higher proportion of admissions "with complications." Higher-volume facilities, despite receiving the most severe burn patients, may provide better patient outcomes than lower-volume facilities. The patterns of discharges found at lower-volume facilities may result in higher diagnosis-related group reimbursement "capture" by lower-volume facilities and higher postdischarge resource use.