Association between physician caseload and patient outcome for sepsis treatment

Abstract

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; P < .001), 40% (95% CI, 0.53-0.68; P < .001), and 18% (95% CI, 0.73-0.92; P < .001), 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.