دورية أكاديمية
أعرض في EDS

Associations of hospital volume and hospital competition with short-term, middle-term and long-term patient outcomes after breast cancer surgery: a retrospective population-based study.

التفاصيل البيبلوغرافية
العنوان: Associations of hospital volume and hospital competition with short-term, middle-term and long-term patient outcomes after breast cancer surgery: a retrospective population-based study.
المؤلفون: van der Schors W; Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands vanderschors@eshpm.eur.nl., Kemp R; Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.; Dutch Authority for Consumers & Markets, The Hague, The Netherlands., van Hoeve J; Department of Research, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands.; Department of Health Technology and Services Research, University of Twente, Enschede, The Netherlands., Tjan-Heijnen V; Department of Medical Oncology, Maastricht UMC+, Maastricht, The Netherlands., Maduro J; Radiotherapy, UMCG, Groningen, The Netherlands., Vrancken Peeters MJ; Department of surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands.; Department of surgery, Amsterdam University Medical Centres, Amsterdam, The Netherlands., Siesling S; Department of Research, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands.; Department of Health Technology & Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, Universiteit Twente, Enschede, The Netherlands., Varkevisser M; Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
المصدر: BMJ open [BMJ Open] 2022 Apr 26; Vol. 12 (4), pp. e057301. Date of Electronic Publication: 2022 Apr 26.
نوع المنشور: Journal Article
اللغة: English
بيانات الدورية: Publisher: BMJ Publishing Group Ltd Country of Publication: England NLM ID: 101552874 Publication Model: Electronic Cited Medium: Internet ISSN: 2044-6055 (Electronic) Linking ISSN: 20446055 NLM ISO Abbreviation: BMJ Open Subsets: MEDLINE
أسماء مطبوعة: Original Publication: [London] : BMJ Publishing Group Ltd, 2011-
مواضيع طبية MeSH: Breast Neoplasms*/surgery, Female ; Hospitals ; Humans ; Margins of Excision ; Mastectomy ; Retrospective Studies
مستخلص: Objectives: For oncological care, there is a clear tendency towards centralisation and collaboration aimed at improving patient outcomes. However, in market-based healthcare systems, this trend is related to the potential trade-off between hospital volume and hospital competition. We analyse the association between hospital volume, competition from neighbouring hospitals and outcomes for patients who underwent surgery for invasive breast cancer (IBC).
Outcome Measures: Surgical margins, 90 days re-excision, overall survival.
Design, Setting, Participants: In this population-based study, we use data from the Netherlands Cancer Registry. Our study sample consists of 136 958 patients who underwent surgery for IBC between 2004 and 2014 in the Netherlands.
Results: Our findings show that treatment types as well as patient and tumour characteristics explain most of the variation in all outcomes. After adjusting for confounding variables and intrahospital correlation in multivariate logistic regressions, hospital volume and competition from neighbouring hospitals did not show significant associations with surgical margins and re-excision rates. For patients who underwent surgery in hospitals annually performing 250 surgeries or more, multilevel Cox proportional hazard models show that survival was somewhat higher (HR 0.94). Survival in hospitals with four or more (potential) competitors within 30 km was slightly higher (HR 0.97). However, this effect did not hold after changing this proxy for hospital competition.
Conclusions: Based on the selection of patient outcomes, hospital volume and regional competition appear to play only a limited role in the explanation of variation in IBC outcomes across Dutch hospitals. Further research into hospital variation for high-volume tumours like the one studied here is recommended to (i) use consistently measured quality indicators that better reflect multidisciplinary clinical practice and patient and provider decision-making, (ii) include more sophisticated measures for hospital competition and (iii) assess the entire process of care within the hospital, as well as care provided by other providers in cancer networks.
Competing Interests: Competing interests: None declared.
(© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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فهرسة مساهمة: Keywords: breast surgery; breast tumours; health policy; quality in health care
تواريخ الأحداث: Date Created: 20220427 Date Completed: 20220428 Latest Revision: 20220716
رمز التحديث: 20231215
مُعرف محوري في PubMed: PMC9045096
DOI: 10.1136/bmjopen-2021-057301
PMID: 35473746
قاعدة البيانات: MEDLINE
الوصف
تدمد:2044-6055
DOI:10.1136/bmjopen-2021-057301