Impact of between-hospital volume and within-hospital volume on mortality and readmission rates for trauma patients in California

Critical Care Medicine
James P Marcin, Patrick S Romano

Abstract

Previous research assessing the impact of between-hospital trauma volume (high volume centers vs. low volume centers) and outcomes has been inconsistent. Furthermore, previous research has not considered temporal variations in within-hospital volume (a center having higher than average volume vs. lower than average volume) as a covariate. The objective of this study was to determine the relationship of between-hospital and within-hospital trauma volume and two measures of hospital quality of care. Multivariable, hierarchical, mixed effects, logistic regression analyses of a population-based nonconcurrent cohort from 1995 to 1999. Thirty-nine nonfederal California hospitals included in the California Patient Discharge Data Set designated by local Emergency Medical Services authorities as adult trauma centers. All nonelderly adult trauma patients, 16-64 yrs (n = 54,352), and elderly adult trauma patients, >65 yrs (n = 47,656), admitted with an Injury Severity Score >9. None. Severity adjusted in-hospital mortality rate and 30-day trauma-related readmissions were analyzed. Among nonelderly adult patients, higher annual between-hospital trauma volume was not associated with mortality rate (odds ratio, 1.02 for each 100 admissions; ...Continue Reading

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