Mortality during hospitalisation for XXXX in Alberta, Canada, is associated with physician volume.

@entity1 @entity221 @entity55
The association of mortality with @entity1 factors (severity of @entity221 , comorbidity), physician factors (specialty training, prehospitalisation visit, in-hospital consultation, volume of @entity1 seen per physician) and healthcare organisation factors ( @entity1 -travel distances, regional beds per capita, admitting hospital-bed occupancy, admitting hospital-bed turnover, hospital location, volume of @entity55 cases per hospital) after hospital admission with community-acquired @entity55 was investigated using administrative data from Alberta, Canada from April 1, 1994-March 31, 1999. During the 5-yr study period there were 43,642 @entity55 hospitalisations, with an 11% in-hospital and 26% 1-yr mortality. @entity1 severity of @entity221 and comorbidity were the strongest predictors of increased mortality. Physicians with the highest in-hospital @entity55 @entity1 volume (>27 @entity1 x yr(-1)) cared for @entity1 with greater severity/comorbidity, but with decreased odds of in-hospital mortality, compared with the lowest volume physicians (less than seven @entity1 per year). The effects of internal medicine specialist or subspecialist care were mixed, with a reduction in deaths for the first 72 h and an increase in in-hospital deaths. Prehospitalisation visit by a physician was associated with decreased mortality. Healthcare organisation factors were the least strong predictor of mortality, demonstrating an effect only for 1-yr mortality in those discharged alive from hospital. Admissions to larger volume or metropolitan hospitals were associated with a decrease in mortality. Severity of @entity221 and comorbidity had the strongest association with mortality. The first association of high-volume physician and pre-hospital care with decreased in-hospital mortality for community-acquired @entity55 is reported.
