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Patients with end-stage kidney disease (ESKD) have a greater risk of comorbidities, including diabetes and anemia, and have higher hospital admission rates than patients with other diseases. The cause of hospital admissions is associated with ESKD prognosis. This retrospective cohort study involved patients with ESKD who received hemodialysis and investigated whether the cause of hospital admission changed before versus after they started hemodialysis. This study recruited 592 patients with ESKD who received hemodialysis at any period between January 2005 and November 2017 and had been assigned the International Classification of Diseases Ninth Revision Clinical Modification (ICD-9-CM) code for ESKD. The patients' demographic data and hospitalization status one year before and two years after they received hemodialysis were analyzed. A McNemar test was conducted to analyze the diagnostic changes from before to after hemodialysis in patients with ESKD. The study's sample of patients with ESKD comprised more women (51.86%) than men and had an average age of 67.15 years. The numbers of patients admitted to the hospital for the following conditions all decreased significantly after they received hemodialysis: type 2 (non-insulin-dependent and adult-onset) diabetes; native atherosclerosis; urinary tract infection; gastric ulcer without mention of hemorrhage, perforation, or obstruction; pneumonia; reflux esophagitis; duodenal ulcer without mention of hemorrhage, perforation, or obstruction; and bacteremia. Most patients exhibited one or more of the following comorbidities: diabetes ( n = 407, 68.75%), hypertension ( n = 491, 82.94%), congestive heart failure ( n = 161, 27.20%), ischemic heart disease ( n = 125, 21.11%), cerebrovascular accident ( n = 93, 15.71%), and gout ( n = 96, 16.22%). An analysis of variance (ANOVA) indicated that changes in the ICD-9-CM codes for native atherosclerosis, urinary tract infection, pneumonia, and hyperkalemia were associated with age. Patients who developed pneumonia before or after they received hemodialysis tended to be older (range: 69-70 years old). This study investigated the causes of hospital admission among patients with ESKD one year before and two years after they received hemodialysis. This study's results revealed hypertension to be the most common comorbidity. Regarding the cause of admission, pneumonia was more prevalent in older than in younger patients. Moreover, changes in the ICD-9-CM codes of native atherosclerosis, urinary tract infection, pneumonia, and hyperkalemia were significantly correlated with age. Therefore, when administering comprehensive nursing care and treatment for ESKD, clinicians should not only focus on comorbidities but also consider factors (e.g., age) that can affect patient prognosis.

Rationale: Although several studies have investigated volume-outcome relationships for surgical procedures, there has been no such study of intensive care unit (ICU) patients admitted for pneumonia., Objectives: This study examines associations between in-hospital mortality of ICU-admitted pneumonia patients and their attending physician's case volume., Methods: We used 2002-2004 claims data from Taiwan's National Health Insurance for all 87,479 adult ICU admissions for pneumonia. Patients were assigned to one of four groups, on the basis of their physician's ICU pneumonia case volume (low volume, <36 cases; medium volume, 37-114 cases; high volume, 118-314 cases; and very high volume, > or =315 cases). Generalized estimating equations (conditional on hospital, and unconditional) were used, adjusting for physician demographics and specialty, hospital characteristics, patient characteristics (including clinical severity and comorbidities), and physician-level random effect (clustering effect) to assess whether physicians' case volume predicts in-hospital mortality., Measurements and Main Results: In-hospital mortality systematically declined with increasing physician case volume: 14.7, 14.3, 11.4, and 8.1% from low-volume to very-high-volume groups. Adjusted unconditional odds of mortality among low-volume physicians' patients were 2.04 times those of very-high-volume physicians, 1.35 times that of high-volume physicians, and 1.09 times those of medium-volume physicians (all P < 0.001). The relationship is sustained when the odds are estimated conditional on hospital, when initial 5-day mortality is separated from 30-day mortality, and when pulmonologists' and critical care specialists' patients are studied separately., Conclusions: Physician volume significantly predicts inpatient mortality among ICU patients with pneumonia. Detailed study of clinical approaches, decision algorithms, and treatment plans of high-volume physicians is recommended to identify possible mediating factors in this phenomenon.

Background: Increasing physician case volumes are documented to reduce costs and improve outcomes for many surgical procedures but not for medical conditions such as pneumonia that consume significant health care resources., Objective: This study explored the association between physicians' inpatient pneumonia case volume and cost per discharge., Design: The design was a retrospective, population-based, cross-sectional study, using National Health Insurance administrative claims data., Setting: The setting was Taiwan., Participants: The participants were a universal sample of 270,002 adult, acute pneumonia hospitalizations, during 2002-2004, excluding transferred cases and readmissions., Measurements: Hierarchical linear regression modeling was used to examine the association of physician's volume (three volume groups, designed to classify patients into approximately equal sized groups) with cost, adjusting for hospital random effects, case severity, physician demographics and specialty, hospital characteristics, and geographic location., Results: Mean cost was NT$2,255 (US$1 = NT$33 in 2004) for low-volume physicians (< or =100 cases) and NT$1,707 for high-volume physicians (> or =316 cases). The adjusted patient costs for low-volume physicians were higher (US$264 and US$235 than high- and medium-volume physicians, respectively; both P < .001), with no difference between high- and medium-volume physicians. High-volume physicians had lower in-hospital mortality and 14-day readmission rates than low-volume physicians., Conclusions: Data support an inverse volume-cost relationship for pneumonia care. Decision processes and clinical care of high-volume physicians versus low-volume physicians should be studied to develop effective care algorithms to improve pneumonia outcomes and reduce costs.

Background: Increasing physician case volumes are documented to reduce costs and improve outcomes for many surgical procedures but not for medical conditions such as pneumonia that consume significant health care resources.Objective: This study explored the association between physicians' inpatient pneumonia case volume and cost per discharge.Design: The design was a retrospective, population-based, cross-sectional study, using National Health Insurance administrative claims data.Setting: The setting was Taiwan.Participants: The participants were a universal sample of 270,002 adult, acute pneumonia hospitalizations, during 2002-2004, excluding transferred cases and readmissions.Measurements: Hierarchical linear regression modeling was used to examine the association of physician's volume (three volume groups, designed to classify patients into approximately equal sized groups) with cost, adjusting for hospital random effects, case severity, physician demographics and specialty, hospital characteristics, and geographic location.Results: Mean cost was NT$2,255 (US$1 = NT$33 in 2004) for low-volume physicians (< or =100 cases) and NT$1,707 for high-volume physicians (> or =316 cases). The adjusted patient costs for low-volume physicians were higher (US$264 and US$235 than high- and medium-volume physicians, respectively; both P < .001), with no difference between high- and medium-volume physicians. High-volume physicians had lower in-hospital mortality and 14-day readmission rates than low-volume physicians.Conclusions: Data support an inverse volume-cost relationship for pneumonia care. Decision processes and clinical care of high-volume physicians versus low-volume physicians should be studied to develop effective care algorithms to improve pneumonia outcomes and reduce costs. [ABSTRACT FROM AUTHOR]