Related Experiment Videos
Heart disease and hospital deaths: an empirical study
1Division of Intramural Research, National Center for Health Services Research, Rockville, MD 20857.
Insights
Hospital and physician experience significantly impacts heart patient survival. High-volume providers and teaching hospitals improve outcomes for acute myocardial infarction (AMI) patients, while coronary care units benefit coronary artery bypass graft (CABG) patients.
Area of Science:
- Health Services Research
- Cardiology Outcomes
- Medical Quality Improvement
Background:
- In-hospital mortality for cardiac patients remains a critical concern.
- Understanding factors influencing survival beyond the initial hospitalization is essential.
- Provider experience and hospital characteristics may play a significant role.
Purpose of the Study:
- To investigate the impact of hospital and physician characteristics on mortality rates for specific cardiac patient groups.
- To determine if provider volume and hospital attributes influence survival in patients undergoing revascularization, catheterization, or with acute myocardial infarction (AMI).
Main Methods:
- Multivariate regression analyses were performed on three distinct patient cohorts.
- Provider experience was measured by the number of similar patients treated by physicians and hospitals.
- Patient severity, demographics, comorbidities, and hospital characteristics (ownership, size, location, teaching status, resources, coronary care unit) were analyzed.
Main Results:
- Coronary care units reduced mortality for coronary artery bypass graft (CABG) patients but not for other groups.
- High hospital procedure volume improved survival for patients undergoing CABG or cardiac catheterization.
- High physician volume for acute myocardial infarction (AMI) patients, board certification of physicians, and teaching hospital status were associated with lower AMI patient mortality.
Conclusions:
- Provider experience and hospital setting are crucial determinants of cardiac patient survival.
- Specialized care settings like coronary care units and high-volume providers benefit specific cardiac procedures.
- For AMI patients, physician expertise (volume, board certification) and hospital affiliation (teaching status) significantly enhance survival.
Abstract:
This study examines the effects of selected characteristics of hospitals and physicians on the mortality rates of heart patients who survive their first day in the hospital. Separate multivariate regression analyses are conducted for three groups: (1) patients who undergo a direct heart revascularization or coronary artery bypass graft (CABG) operation; (2) patients who undergo a cardiac catheterization and do not undergo a CABG operation; and (3) patients with a principal diagnosis of acute myocardial infarction (AMI) who do not undergo surgery. The number of patients in each group treated by specific physicians, and the number treated in specific hospitals, measure provider experience with similar patients. Other hypothesized determinants of in-hospital mortality include: (1) patient severity of illness, age, sex, and the presence of comorbidities; (2) hospital ownership, size, location, teaching status, resources expended, and the presence of a coronary care unit; and (3) board certification status of the attending physician or surgeon who operated. Empirical results show that presence of a coronary care unit decreases the chance that CABG patients will die in the hospital but is not significant for other heart patients included in this study. Patients with atherosclerosis who receive a CABG or a cardiac catheterization procedure are more likely to survive in hospitals with high volumes of these procedures. However, hospital volume of AMI admissions was not a factor in survival; AMI patients are more likely to survive when their attending physicians treat high volumes of AMI patients. Also, AMI patients whose physicians are board certified in family practice or in internal medicine are less likely to die compared to AMI patients with physicians not board certified. Similarly, AMI patients hospitalized in teaching facilities are less likely to die compared to AMI patients in hospitals not affiliated with a medical school.