• Mihaela S Stefan, Penelope S Pekow, Meng-Shiou Shieh, Nicholas S Hill, Michael B Rothberg, Kimberly A Fisher, and Peter K Lindenauer.
• 1Center for Quality of Care Research, Baystate Medical Center, Springfield, MA. 2Division of General Medicine, Department of Medicine, Baystate Medical Center, Springfield, MA. 3Tufts University School of Medicine, Boston, MA. 4School of Public Health and Health Sciences, University of Massachusetts-Amherst, Amherst, MA. 5Division of Pulmonary and Critical Care Medicine, Department of Medicine, Tufts University School of Medicine, Boston, MA. 6Center for Value Based Research, Medicine Institute, Cleveland Clinic, Cleveland, OH. 7Division of Pulmonary and Critical Care, Department of Medicine, University of Massachusetts Medical School, Worcester, MA.
• Crit. Care Med. 2017 Jan 1; 45 (1): 20-27.

ObjectiveTo determine the relationship between hospital noninvasive ventilation caseload and outcomes among patients with an acute chronic obstructive pulmonary disease exacerbation.DesignCross-sectional study of 13,893 patients with chronic obstructive pulmonary disease treated with noninvasive ventilation.SettingA total of 243 U.S. hospitals participating in the Premier Inpatient Database.PatientsA total of 13,893 patients admitted between July 2009 and June 2011.InterventionsNone.Measurements And Main ResultsAnnual hospital volume of noninvasive ventilation was analyzed as a continuous variable, as well as after grouping it in four categories. The median hospital annual volume of noninvasive ventilation use was 627 and varied from 234 admissions in quartile 1 to 1,529 admissions in quartile 4. Noninvasive ventilation failure occurred in 15.2%, and in-hospital mortality was 6.5%. After adjusting for patient characteristics, relative to low-volume hospitals, high-volume hospitals did not have lower noninvasive ventilation failure (odds ratio quartile 4 vs quartile 1, 1.05; 95% CI, 0.65-1.68) or in-hospital mortality (odds ratio quartile 4 vs quartile 1, 0.88; 95% CI, 0.69-1.12). In a hierarchical multivariable analysis with adjustment for patient characteristics where volume was assessed as a continuous variable, hospital volume was not related to outcomes, including noninvasive ventilation failure (p = 0.87), in-hospital mortality (p = 0.88), 30-day readmission for chronic obstructive pulmonary disease (p = 0.83), or hospital length of stay (p = 0.12).ConclusionsThe results of this large retrospective cohort study suggest that hospitals with higher noninvasive ventilation volume do not achieve better outcomes of patients with chronic obstructive pulmonary disease exacerbation treated with noninvasive ventilation; even hospitals with low noninvasive ventilation volume are able to successfully implement this intervention.

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