Hospital resource intensity and cirrhosis mortality in United States

Amit Mathur, Apurba K. Chakrabarti, Jessica L. Mellinger, Michael L. Volk, Ryan Day, Andrew L. Singer, Winston R. Hewitt, Kunam Sudhakar Reddy, Adyr A. Moss

Research output: Contribution to journalArticle

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)1857-1865
Number of pages9
JournalWorld Journal of Gastroenterology
Volume23
Issue number10
DOIs
StatePublished - Mar 14 2017

Fingerprint

Fibrosis
Mortality
Odds Ratio
Inpatients
American Hospital Association
Delivery of Health Care
Diagnosis-Related Groups
Medicaid
Hospital Mortality
Cluster Analysis
Liver Diseases
Length of Stay
Patient Care
Hospitalization
Transplants
Survival
Liver

Keywords

  • Cirrhosis
  • Hospital variation
  • Mortality
  • Outcomes
  • Quality
  • Resource utilization

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Mathur, A., Chakrabarti, A. K., Mellinger, J. L., Volk, M. L., Day, R., Singer, A. L., ... Moss, A. A. (2017). Hospital resource intensity and cirrhosis mortality in United States. World Journal of Gastroenterology, 23(10), 1857-1865. https://doi.org/10.3748/wjg.v23.i10.1857

Hospital resource intensity and cirrhosis mortality in United States. / Mathur, Amit; Chakrabarti, Apurba K.; Mellinger, Jessica L.; Volk, Michael L.; Day, Ryan; Singer, Andrew L.; Hewitt, Winston R.; Reddy, Kunam Sudhakar; Moss, Adyr A.

In: World Journal of Gastroenterology, Vol. 23, No. 10, 14.03.2017, p. 1857-1865.

Research output: Contribution to journalArticle

Mathur, A, Chakrabarti, AK, Mellinger, JL, Volk, ML, Day, R, Singer, AL, Hewitt, WR, Reddy, KS & Moss, AA 2017, 'Hospital resource intensity and cirrhosis mortality in United States', World Journal of Gastroenterology, vol. 23, no. 10, pp. 1857-1865. https://doi.org/10.3748/wjg.v23.i10.1857
Mathur, Amit ; Chakrabarti, Apurba K. ; Mellinger, Jessica L. ; Volk, Michael L. ; Day, Ryan ; Singer, Andrew L. ; Hewitt, Winston R. ; Reddy, Kunam Sudhakar ; Moss, Adyr A. / Hospital resource intensity and cirrhosis mortality in United States. In: World Journal of Gastroenterology. 2017 ; Vol. 23, No. 10. pp. 1857-1865.
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abstract = "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.",
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AU - Mathur, Amit

AU - Chakrabarti, Apurba K.

AU - Mellinger, Jessica L.

AU - Volk, Michael L.

AU - Day, Ryan

AU - Singer, Andrew L.

AU - Hewitt, Winston R.

AU - Reddy, Kunam Sudhakar

AU - Moss, Adyr A.

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N2 - 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.

AB - 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.

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KW - Mortality

KW - Outcomes

KW - Quality

KW - Resource utilization

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