NDLI: Effects of institutional caseload of subarachnoid hemorrhage on mortality: a secondary analysis of administrative data.

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Effects of institutional caseload of subarachnoid hemorrhage on mortality: a secondary analysis of administrative data.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Matta, Basil F. McNeill, Lisa Menon, David K. English, Shane W. Borg, Nicholas
Spatial Coverage	England
Description	Country affiliation: United kingdom Author Affiliation: McNeill L ( University of Cambridge, Cambridge CB1 8RN, UK. lm509@medschl.cam.ac.uk)
Abstract	BACKGROUND AND PURPOSE: Procedures requiring specific skill sets often have been shown to depend on institutional volume, that is, centers receiving a higher volume observe better outcomes in those patients. This relationship recently has been shown to exist for subarachnoid hemorrhage(SAH) patients in a large study in the United States. We aim to examine this relationship for SAH patients in England, restricting analysis to specialist neurosurgical units. METHODS: Aggregate counts of patients with SAH in 25 specialist neuroscience centers in England, from 2005 to 2011, were obtained from the Hospital Episode Statistics database maintained by the National Health Service Information Center. These data were linked with national mortality statistics to obtain counts of deaths. Poisson regression was used to investigate the relationship between institutional caseload of SAH and 6-month mortality from any cause. Six-month mortality rates and mortality ratios were computed. RESULTS: Annual institutional caseload of admissions with SAH was inversely related to 6-month mortality (P=0.009; r(2)=0.26). Each 100-patient increase in annual patient volume was associated with a 24% reduction in mortality (adjusted mortality ratio, 0.76; confidence interval, 0.67-0.87). This relationship was consistent across the entire range of annual institutional caseloads examined (29-367 cases for the lowest and highest volumes seen in a single center in 1 year). CONCLUSIONS: Our results provide support for management of SAH at high-volume centers and suggest that health care policy in this setting should pursue regionalization while ensuring an adequate geographic spread of access to care.
ISSN	00392499
e-ISSN	15244628
Journal	Stroke
Issue Number	3
Volume Number	44
Language	English
Publisher	Lippincott Williams & Wilkins (on behalf of the American Heart Association)
Publisher Date	2013-03-01
Publisher Place	United States
Access Restriction	Open
Subject Keyword	Hospital Administration Statistics & Numerical Data Hospitals, High-volume Hospitals, Low-volume Subarachnoid Hemorrhage Mortality Hospitalization Longitudinal Studies Poisson Distribution Retrospective Studies State Medicine Comparative Study Multicenter Study Research Support, Non-u.s. Gov't Discipline Cardiology
Content Type	Text
Resource Type	Article
Subject	Cardiology and Cardiovascular Medicine Neuroscience Advanced and Specialized Nursing Neurology (clinical)

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