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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 and Author 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
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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.

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

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