Reviewer's report
Title:The Effect of Hospital Volume on Patient Outcomes in Severe Acute
Pancreatitis
Version: 3Date:25 April 2012
Reviewer: Atsuhiko Murata
Reviewer's report:
Authors investigated the hospital volume-outcome relationship in patients with
severe acute pancreatitis based on the Taiwan National Health Insurance
Research Database. They found that increasing hospital volume was associated
with a reduced risk of hospital mortality after adjusting for patient and hospital
characteristics while the volume effect on hospital mortality disappeared after
adjusting for treatment covariates. They concluded that these findings support
volume-based selective referral for patients with severe acute pancreatitis and
suggest that differences in levels or processes of care across hospitals may have
contributed to the volume effect.
I think that this paper is well-designed and well-written. However, some revisions
are required. Please consider the following points.
Major compulsory revisions
1. Authors found that there was a significant association between hospital
volume and the mortality of patients with severe acute pancreatitis in Model 1
(taking account into the patient and hospital characteristics). However, the
volume effect disappeared in Model 2 (taking account into not only patient and
hospital characteristics but also selected treatments such as cholecystectomy or
life-support measures). This finding is very interesting and highly suggestive.
Authors should describe the reasons why the volume effect on hospital mortality
disappeared after adjusting for treatment covariates, as well as comparisons with
the previous papers. Please clarify the mechanism of these results.
2. There is very little description of the hospital length of stay (LOS) or hospital
charges in the Discussion. While there was a significant association between
hospital volume and LOS, the hospital volume was not independent factor for
hospital charge in both Model 1 and 2. Why hospital volume did not affect
hospital charge in this study?
3. How the results of this study influence the treatments for severe acute
pancreatitis in Taiwan? In order to explain the importance of this study for severe
acute pancreatitis, it is necessary for authors to describe the health policy and
future research for the treatments of severe acute pancreatitis in Taiwan.
Minor essential revisions
1. What is the meaning of excluding the patients in the 1990’s?
2. There are three kinds of hospital ownership in Table 1. What does the
hospitals without profiting mean?
Discretionary revisions
1. Authors had better use lower case letters in the title of reference 5. (Effect of
hospital volume on clinical outcomes########)
2. In Table 3, the column of hospital volume has been partly obscured.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Needs some language corrections before being
published
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests.
Reviewer's report
Title:The Effect of Hospital Volume on Patient Outcomes in Severe Acute
Pancreatitis
Version: 3Date:25 April 2012
Reviewer: Atsuhiko Murata
Reviewer's report:
Authors investigated the hospital volume-outcome relationship in patients with
severe acute pancreatitis based on the Taiwan National Health Insurance
Research Database. They found that increasing hospital volume was associated
with a reduced risk of hospital mortality after adjusting for patient and hospital
characteristics while the volume effect on hospital mortality disappeared after
adjusting for treatment covariates. They concluded that these findings support
volume-based selective referral for patients with severe acute pancreatitis and
suggest that differences in levels or processes of care across hospitals may have
contributed to the volume effect.
I think that this paper is well-designed and well-written. However, some revisions
are required. Please consider the following points.
Major compulsory revisions
1. Authors found that there was a significant association between hospital
volume and the mortality of patients with severe acute pancreatitis in Model 1
(taking account into the patient and hospital characteristics). However, the
volume effect disappeared in Model 2 (taking account into not only patient and
hospital characteristics but also selected treatments such as cholecystectomy or
life-support measures). This finding is very interesting and highly suggestive.
Authors should describe the reasons why the volume effect on hospital mortality
disappeared after adjusting for treatment covariates, as well as comparisons with
the previous papers. Please clarify the mechanism of these results.
2. There is very little description of the hospital length of stay (LOS) or hospital
charges in the Discussion. While there was a significant association between
hospital volume and LOS, the hospital volume was not independent factor for
hospital charge in both Model 1 and 2. Why hospital volume did not affect
hospital charge in this study?
3. How the results of this study influence the treatments for severe acute
pancreatitis in Taiwan? In order to explain the importance of this study for severe
acute pancreatitis, it is necessary for authors to describe the health policy and
future research for the treatments of severe acute pancreatitis in Taiwan.
Minor essential revisions
1. What is the meaning of excluding the patients in the 1990’s?
2. There are three kinds of hospital ownership in Table 1. What does the
hospitals without profiting mean?
Discretionary revisions
1. Authors had better use lower case letters in the title of reference 5. (Effect of
hospital volume on clinical outcomes########)
2. In Table 3, the column of hospital volume has been partly obscured.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Needs some language corrections before being
published
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests.
Please review this paper.
user
Reviewer's report
Title:The Effect of Hospital Volume on Patient Outcomes in Severe Acute
Pancreatitis
Version: 3Date:25 April 2012
Reviewer: Atsuhiko Murata
Reviewer's report:
Authors investigated the hospital volume-outcome relationship in patients with
severe acute pancreatitis based on the Taiwan National Health Insurance
Research Database. They found that increasing hospital volume was associated
with a reduced risk of hospital mortality after adjusting for patient and hospital
characteristics while the volume effect on hospital mortality disappeared after
adjusting for treatment covariates. They concluded that these findings support
volume-based selective referral for patients with severe acute pancreatitis and
suggest that differences in levels or processes of care across hospitals may have
contributed to the volume effect.
I think that this paper is well-designed and well-written. However, some revisions
are required. Please consider the following points.
Major compulsory revisions
1. Authors found that there was a significant association between hospital
volume and the mortality of patients with severe acute pancreatitis in Model 1
(taking account into the patient and hospital characteristics). However, the
volume effect disappeared in Model 2 (taking account into not only patient and
hospital characteristics but also selected treatments such as cholecystectomy or
life-support measures). This finding is very interesting and highly suggestive.
Authors should describe the reasons why the volume effect on hospital mortality
disappeared after adjusting for treatment covariates, as well as comparisons with
the previous papers. Please clarify the mechanism of these results.
2. There is very little description of the hospital length of stay (LOS) or hospital
charges in the Discussion. While there was a significant association between
hospital volume and LOS, the hospital volume was not independent factor for
hospital charge in both Model 1 and 2. Why hospital volume did not affect
hospital charge in this study?
3. How the results of this study influence the treatments for severe acute
pancreatitis in Taiwan? In order to explain the importance of this study for severe
acute pancreatitis, it is necessary for authors to describe the health policy and
future research for the treatments of severe acute pancreatitis in Taiwan.
Minor essential revisions
1. What is the meaning of excluding the patients in the 1990’s?
2. There are three kinds of hospital ownership in Table 1. What does the
hospitals without profiting mean?
Discretionary revisions
1. Authors had better use lower case letters in the title of reference 5. (Effect of
hospital volume on clinical outcomes########)
2. In Table 3, the column of hospital volume has been partly obscured.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Needs some language corrections before being
published
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests.
assistant