Relationship between caseload volume and outcome for systemic lupus erythematosus treatment: The experience of Taiwan

Tzu Feng Wang, Herng Ching Lin

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Objective. To determine if a physician's experience or hospital caseload volume is associated with in-hospital mortality of patients with systemic lupus erythematosus (SLE). Methods. We used data from Taiwan's National Health Insurance Research Database covering 2002 to 2004. A total of 8536 hospital admissions citing a principal diagnosis of SLE were selected. Hospitals with an average of > 50, 26-50, and <26 SLE cases per year were categorized as high, medium, and low-caseload-volume hospitals, respectively. Physician caseload volume was defined as low (> 1 SLE case per year), medium (1-3 cases per year), and high-volume (> 3 cases per year). Multivariate logistic regression analyses employing generalized estimated equations were performed to assess the independent association between physician or hospital SLE caseload volume and in-hospital mortality, after adjusting for other factors. Results. We found that in-hospital mortality declined with increasing physician caseload volume (3.0%, 1.0%, and 0.8% for low, medium, and high-volume physicians, respectively), with the adjusted odds of in-hospital mortality for patients treated by low-volume physicians being 2.681 (p <0.05) times greater than for patients treated by medium-volume physicians, and 3.195 (p <0.001) times greater than for those treated by high-volume physicians. No significant relationship was found between in-hospital mortality and hospital SLE caseload volume (p = 0.896). Conclusion. We concluded that the factor of physicians' experience treating SLE is more crucial in determining in-hospital mortality than a hospital's annual SLE caseload. The Journal of Rheumatology

Original languageEnglish
Pages (from-to)1795-1800
Number of pages6
JournalJournal of Rheumatology
Volume35
Issue number9
Publication statusPublished - Sep 2008

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Taiwan
Systemic Lupus Erythematosus
Hospital Mortality
Physicians
Therapeutics
National Health Programs
Rheumatology
Logistic Models
Regression Analysis
Databases
Research

Keywords

  • In-hospital mortality
  • Systemic lupus erythematosus
  • Volume-outcome

ASJC Scopus subject areas

  • Rheumatology
  • Immunology
  • Immunology and Allergy

Cite this

Relationship between caseload volume and outcome for systemic lupus erythematosus treatment : The experience of Taiwan. / Wang, Tzu Feng; Lin, Herng Ching.

In: Journal of Rheumatology, Vol. 35, No. 9, 09.2008, p. 1795-1800.

Research output: Contribution to journalArticle

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abstract = "Objective. To determine if a physician's experience or hospital caseload volume is associated with in-hospital mortality of patients with systemic lupus erythematosus (SLE). Methods. We used data from Taiwan's National Health Insurance Research Database covering 2002 to 2004. A total of 8536 hospital admissions citing a principal diagnosis of SLE were selected. Hospitals with an average of > 50, 26-50, and <26 SLE cases per year were categorized as high, medium, and low-caseload-volume hospitals, respectively. Physician caseload volume was defined as low (> 1 SLE case per year), medium (1-3 cases per year), and high-volume (> 3 cases per year). Multivariate logistic regression analyses employing generalized estimated equations were performed to assess the independent association between physician or hospital SLE caseload volume and in-hospital mortality, after adjusting for other factors. Results. We found that in-hospital mortality declined with increasing physician caseload volume (3.0{\%}, 1.0{\%}, and 0.8{\%} for low, medium, and high-volume physicians, respectively), with the adjusted odds of in-hospital mortality for patients treated by low-volume physicians being 2.681 (p <0.05) times greater than for patients treated by medium-volume physicians, and 3.195 (p <0.001) times greater than for those treated by high-volume physicians. No significant relationship was found between in-hospital mortality and hospital SLE caseload volume (p = 0.896). Conclusion. We concluded that the factor of physicians' experience treating SLE is more crucial in determining in-hospital mortality than a hospital's annual SLE caseload. The Journal of Rheumatology",
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