Estimates of the effects of centralization policy for surgery in Japan: does centralization affect the quality of healthcare for esophagectomies?
Estimates of the effects of centralization policy for surgery in Japan: does centralization affect the quality of healthcare for esophagectomies?
复制标题
日本手术集中化政策效果评估：集中化是否会影响食管切除术的医疗质量？
DOI：
10.1007/s00595-021-02245-1
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发表时间：
2021
期刊：
影响因子：
2.5
通讯作者：
Miyata Hiroaki
中科院分区：
文献类型：
--
作者：
Takahashi Arata;Yamamoto Hiroyuki;Kakeji Yoshihiro;Marubashi Shigeru;Gotoh Mitsukazu;Seto Yasuyuki;Miyata Hiroaki
目的本研究比较了医疗服务体系重组政策实施前后的医疗质量，并评估了集中化的影响。方法我们使用国家临床数据库对 2011 年至 2016 年接受食管切除术的患者进行研究。我们根据患者背景、手术死亡率和手术年份比较了集中化的效果。在调整患者水平的预期手术死亡率后，采用基于广义估计方程逻辑回归模型的双重差分法进行前后比较。结果总共识别出34,640例。在超低容量医院中发现了更多具有危险因素的病例，其中 38.4% 的病例接受了人口稀少地区的治疗，而在这些医院中接受治疗的患者的手术死亡率、30 天内的再入院率和住院时间都更差。在集中地区，每家医院的病例数随着时间的推移而增加（2011年的7.2例至2016年的9.5例），而粗手术死亡率则呈下降趋势（2011年的3.4%至2016年的1.8%）。双重差分估计量为0.856（95%置信区间：0.639-1.147，p= 0.298）。结论超低容量医院的集中化并没有导致护理质量的恶化，反而呈改善趋势。
PurposeThis study compared the quality of healthcare before and after implementation of a policy restructuring the healthcare delivery system and estimated the impact of centralization.MethodsWe used the National Clinical Database to study patients undergoing esophagectomies from 2011 to 2016. We compared the effect of centralization based on the patient background, surgical mortality, and year of surgery. Difference-in-difference methods based on the generalized estimating equation logistic regression model were used for before-and-after comparisons after adjusting for patient-level expected surgical mortality.ResultsIn total, 34,640 cases were identified. More cases with risk factors were noted in ultra-low-volume hospitals, where 38.4% of cases in underpopulated areas were treated, than in higher volume facilities, and the operative mortality, readmission within 30 days and length of stay were worse among patients treated in these hospitals. In centralized prefectures, the number of cases per hospital increased over time (7.2 in 2011 to 9.5 in 2016) while the crude operative mortality tended to decrease (3.4% in 2011 to 1.8% in 2016). The difference-in-difference estimator was 0.856 (95% confidence interval: 0.639–1.147,p= 0.298).ConclusionThe centralization of ultra-low-volume hospitals did not lead to a deterioration in the quality of care but rather an improving trend.