Relationship Between Caseload Volume and Outcome for Systemic Lupus Erythematosus Treatment: The Experience of Taiwan

TZU-FENG WANG and HERNG-CHING LIN

ABSTRACT.

Objective. To determine if a physician's experience or hospital caseload volume is associated with in-hospital mortality of patients with systemic lupus erythematosus (SLE).

Methods. We used data from Taiwan's National Health Insurance Research Database covering 2002 to 2004. A total of 8536 hospital admissions citing a principal diagnosis of SLE were selected. Hospitals with an average of > 50, 26–50, and < 26 SLE cases per year were categorized as high, medium, and low-caseload-volume hospitals, respectively. Physician caseload volume was defined as low (< 1 SLE case per year), medium (1–3 cases per year), and high-volume (> 3 cases per year). Multivariate logistic regression analyses employing generalized estimated equations were performed to assess the independent association between physician or hospital SLE caseload volume and in-hospital mortality, after adjusting for other factors.

Results. We found that in-hospital mortality declined with increasing physician caseload volume (3.0%, 1.0%, and 0.8% for low, medium, and high-volume physicians, respectively), with the adjusted odds of in-hospital mortality for patients treated by low-volume physicians being 2.681 (p < 0.05) times greater than for patients treated by medium-volume physicians, and 3.195 (p < 0.001) times greater than for those treated by high-volume physicians. No significant relationship was found between in-hospital mortality and hospital SLE caseload volume (p = 0.896).

Conclusion. We concluded that the factor of physicians' experience treating SLE is more crucial in determining in-hospital mortality than a hospital's annual SLE caseload. (First Release Aug 15 2008; J Rheumatol 2008;35:1795-800)

Key Indexing Terms:

SYSTEMIC LUPUS ERYTHEMATOSUS
VOLUME-OUTCOME
IN-HOSPITAL MORTALITY

---

From the Department of Family Medicine, Wan Fang Hospital; and School of Health Care Administration, Taipei Medical University, Taipei, Taiwan.

Sponsored by the Taipei Medical University-Wan Fang Hospital (94TMU-WFH-206).

T-F. Wang, MD, Department of Family Medicine, Wan Fang Hospital; H-C. Lin, PhD, School of Health Care Administration, Taipei Medical University.

Address reprint requests to H-C. Lin, School of Health Care Administration, Taipei Medical University, 250 Wu-Hsing St., Taipei 110, Taiwan.

Accepted for publication April 10, 2008.

---