The full content of Annals is available to subscribers

Subscribe/Learn More  >
Improving Patient Care |

Volume, Quality of Care, and Outcome in Pneumonia

Peter K. Lindenauer, MD, MSc; Raj Behal, MD, MPH; Cynthia K. Murray, PhD; Wato Nsa, MD, PhD; Peter M. Houck, MD; and Dale W. Bratzler, DO, MPH
[+] Article, Author, and Disclosure Information

From Baystate Medical Center, Springfield, Massachusetts; Tufts University School of Medicine, Medford, Massachusetts; University HealthSystem Consortium, Oak Brook, Illinois; Northwestern University Feinberg School of Medicine, Chicago, Illinois; University of Central Oklahoma, Edmond, Oklahoma; Oklahoma Foundation for Medical Quality, Oklahoma City, Oklahoma; and School of Public Health and Community Medicine, University of Washington, Seattle, Washington.

Disclaimer: The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. government. The authors assume full responsibility for the accuracy and completeness of the ideas presented.

Grant Support: The analyses on which this publication is based were performed under contract number 500-99-P619, titled “Utilization and Quality Control Peer Review Organization for the State of Oklahoma,” sponsored by the Centers for Medicare & Medicaid Services (CMS), Department of Health and Human Services. This article is a direct result of the Health Care Quality Improvement Program initiated by CMS, which has encouraged identification of quality improvement projects derived from analyses of patterns of care, and therefore required no special funding on the part of this contractor.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Peter K. Lindenauer, MD, MSc, Division of Healthcare Quality, Baystate Medical Center, 759 Chestnut Street P-5931, Springfield, MA 01199; e-mail, Peter.Lindenauer@bhs.org.

Current Author Addresses: Dr. Lindenauer: Division of Healthcare Quality, Baystate Medical Center, 759 Chestnut Street P-5931, Springfield, MA 01199.

Dr. Behal: University HealthSystem Consortium, Suite 700, 2001 Spring Road, Oak Brook, IL 60523.

Dr. Murray: University of Central Oklahoma, 100 North University Drive, Edmond, OK 73303.

Drs. Nsa and Bratzler: Oklahoma Foundation for Medical Quality, 14000 Quail Springs Parkway, Oklahoma City, OK 73134.

Dr. Houck: U.S. Public Health Service, 2201 Sixth Avenue, MS-20, Seattle, WA 98121.

Ann Intern Med. 2006;144(4):262-269. doi:10.7326/0003-4819-144-4-200602210-00008
Text Size: A A A

In this large observational study, higher volume failed to translate into either improved quality of care or better outcomes for patients hospitalized for the treatment of pneumonia. On the contrary, physicians who cared for the greatest number of patients with pneumonia were 40% less likely to administer vaccinations, and hospital volume was inversely associated with the timely administration of antibiotics. Physician volume was not associated with in-hospital or 30-day mortality rates, and odds ratios for 30-day mortality rates were similar among hospital groups.

First Page Preview

View Large
First page PDF preview


Grahic Jump Location
Selection of study sample.

ICD-9-CM = International Classification of Diseases, Ninth Revision, Clinical Modification; UPIN = unique provider identification code.

Grahic Jump Location




Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now for $32.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Related Point of Care
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.