Costs and concentration of cancer care: evidence for pancreatic, oesophageal and gastric cancers in National Health Service hospitals.
Costs and concentration of cancer care: evidence for pancreatic, oesophageal and gastric cancers in National Health Service hospitals.
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DOI：
10.1258/135581903321466030
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发表时间：
2003-04-01
影响因子：
2.4
通讯作者：
Harvey, Ian
中科院分区：
文献类型：
--
作者：
Bachmann, Max;Peters, Tim;Harvey, Ian
目的：检查医院癌症护理的成本和患者的医生和医院的专业化程度之间的关系，表明他们每年的cases-loads.METHODS：三个队列，包括2294例胰腺癌，食道癌和胃癌患者在29个急性国家卫生服务（NHS）在英格兰西南部和南威尔士的医院进行了前瞻性随访一年。记录每例患者的预后变量、服务活动和生存数据，并估计癌症护理的医院成本和每年生存的成本。费用是根据所提供的资源单位数量和一套单一的单位费用估算的。住院后每天的生存成本计算为成本效益估计值。线性回归分析研究了对总成本的影响，并对每天生存的医生和医院的年度病人数量的成本，调整预后变量和treatment.RESULTS：一般病房护理，而不是具体的治疗和调查占总成本的大部分。随着医生数量的增加，每位患者的成本显著增加。然而，在调整预后和治疗后，成本-容量关系呈U形，反映了高容量医生更积极的干预，沿着低容量医生的患者活动少且住院时间长。生存日成本与医生数量呈U型关系。回归模型使用连续的，而不是分类量项拟合databest.Conclusions：医生的专业化至少是医院的专业化的效率和效果一样重要。随着医生数量的增加，每天的成本和费用先增加后减少，这突出表明，随着服务变得高度专业化，需要对成本给予高度关注。专业化沿着一个连续体发生，对生存或成本没有明确的数量阈值效应。
OBJECTIVES: To examine relationships between the cost of hospital cancer care and the degree of specialisation of patients' doctors and hospitals as indicated by their annual case-loads.METHODS: Three cohorts comprising 2294 patients with cancers of the pancreas, oesophagus and stomach in 29 acute National Health Service (NHS) hospitals in south-west England and South Wales were followed prospectively for a year. For each patient, prognostic variables, service activity and survival data were recorded, and the hospital cost of cancer care and cost per year survived were estimated. Costs were estimated from quantities of resource units provided and a single set of unit costs. Costs per day survived after presentation to hospital were calculated as estimates of cost-effectiveness. Linear regression analyses examined the effects on total costs, and on costs per day survived of doctors' and hospitals' annual patient volumes, adjusting for prognostic variables and treatments.RESULTS: General ward care rather than specific treatments and investigations accounted for most of total costs. Costs per patient increased significantly with increasing doctor volumes. After adjustment for prognosis and treatments, however, cost-volume relationships were U-shaped, reflecting more active intervention by higher volume doctors, along with little activity and long stays among patients of lower volume doctors. Cost per day survived also had U-shaped relationships with doctor volumes. Regression models using continuous rather than categorical volume terms fitted the data best.CONCLUSIONS: Doctors' specialisation is at least as important for efficiency and effectiveness as hospitals' specialisation. Cost and cost per day survived increased and then decreased with increasing doctor volumes, highlighting the need for critical attention to costs as services become highly specialised. Specialisation occurs along a continuum, with no clear volume threshold effects on survival or costs.