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Association Between Physician Caseload and Patient Outcome for Sepsis Treatment

Chao‐Hung Chen , MD, MPH;, Yi‐Hua Chen , PhD;, Hsiu‐Chen Lin , MD; and Herng‐Ching Lin , PhD
Infection Control and Hospital Epidemiology
Vol. 30, No. 6 (June 2009), pp. 556-562
DOI: 10.1086/597509
Stable URL:
Page Count: 7
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Association Between Physician Caseload and Patient Outcome for Sepsis Treatment
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Objective.  The purpose of this study was to investigate whether physicians with larger sepsis caseloads provide better outcomes, defined as lower in‐hospital mortality rates, for patients with sepsis. Design.  Retrospective cross‐sectional study. Method.  This study used pooled data from the 2002–2004 Taiwan National Health Insurance Research Database. A total of 48,336 patients hospitalized with a principal diagnosis of septicemia were selected and assigned to 1 of 4 caseload groups on the basis of their treating physician's sepsis caseload during the 3 years reflected in the pooled data (low caseload, less than 39 cases; medium caseload, 39–88 cases; high caseload, 89–176 cases; and very high caseload, more than 176 cases). Generalized estimating equation models were used for analysis. Results.  Receipt of treatment from physicians in the very high, high, and medium caseload groups decreased patients’ odds of in‐hospital mortality by 49% (95% confidence interval [CI], 0.41–0.67; \documentclass{aastex} \usepackage{amsbsy} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{bm} \usepackage{mathrsfs} \usepackage{pifont} \usepackage{stmaryrd} \usepackage{textcomp} \usepackage{portland,xspace} \usepackage{amsmath,amsxtra} \usepackage[OT2,OT1]{fontenc} \newcommand\cyr{ \renewcommand\rmdefault{wncyr} \renewcommand\sfdefault{wncyss} \renewcommand\encodingdefault{OT2} \normalfont \selectfont} \DeclareTextFontCommand{\textcyr}{\cyr} \pagestyle{empty} \DeclareMathSizes{10}{9}{7}{6} \begin{document} \landscape $P< .001$ \end{document} ), 40% (95% CI, 0.53–0.68; \documentclass{aastex} \usepackage{amsbsy} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{bm} \usepackage{mathrsfs} \usepackage{pifont} \usepackage{stmaryrd} \usepackage{textcomp} \usepackage{portland,xspace} \usepackage{amsmath,amsxtra} \usepackage[OT2,OT1]{fontenc} \newcommand\cyr{ \renewcommand\rmdefault{wncyr} \renewcommand\sfdefault{wncyss} \renewcommand\encodingdefault{OT2} \normalfont \selectfont} \DeclareTextFontCommand{\textcyr}{\cyr} \pagestyle{empty} \DeclareMathSizes{10}{9}{7}{6} \begin{document} \landscape $P< .001$ \end{document} ), and 18% (95% CI, 0.73–0.92; \documentclass{aastex} \usepackage{amsbsy} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{bm} \usepackage{mathrsfs} \usepackage{pifont} \usepackage{stmaryrd} \usepackage{textcomp} \usepackage{portland,xspace} \usepackage{amsmath,amsxtra} \usepackage[OT2,OT1]{fontenc} \newcommand\cyr{ \renewcommand\rmdefault{wncyr} \renewcommand\sfdefault{wncyss} \renewcommand\encodingdefault{OT2} \normalfont \selectfont} \DeclareTextFontCommand{\textcyr}{\cyr} \pagestyle{empty} \DeclareMathSizes{10}{9}{7}{6} \begin{document} \landscape $P< .001$ \end{document} ), respectively, compared with the odds for patients treated by low‐caseload physicians. These findings persisted after partitioning out systematic physician‐specific and hospital‐specific variation and isolating the effects of most hospital, physician, and patient confounders. Conclusion.  Patients treated by physicians who had a larger sepsis caseload had a substantially lower in‐hospital mortality rate than did patients treated by physicians in the other caseload groups, and the difference was statistically significant. This result supports the “practice makes perfect” hypothesis.

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