Hospital factors and patient characteristics in the treatment of colorectal cancer: a population based study.
Hospital factors and patient characteristics in the treatment of colorectal cancer: a population based study.
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DOI：
10.1186/1471-2458-12-775
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发表时间：
2012-09-12
影响因子：
4.5
通讯作者：
Ciccone G
中科院分区：
文献类型：
--
作者：
Sacerdote C;Baldi I;Bertetto O;Dicuonzo D;Farina E;Pagano E;Rosato R;Senore C;Merletti F;Ciccone G
本研究的重点是分析社会，临床和医院的特点，可能会导致差异的管理和结果的护理。为此，指标的初始治疗提供给新诊断的结直肠癌患者在西北部地区的意大利，使用行政数据进行了调查。该队列包括8年期间（2000-2007年）通过经验证的算法从皮埃蒙特医院出院记录系统中选择的所有新发结直肠癌患者（N = 24，187）。在这个以人群为基础的队列中，评估了三个护理质量指标：直肠癌患者术前放疗（RT）和腹会阴（AP）切除的比例，以及结直肠癌患者术后住院死亡率的比例。在直肠癌中，与年轻患者相比，老年患者术前接受RT的可能性较小，更有可能接受AP切除术。与男性相比，女性接受术前RT和AP切除术的概率降低（比值比（OR）分别为0.77，95%置信区间（CI）为0.64-0.93和0.78，95%CI为0.69-0.89）。然而，存在RT随时间增加的趋势（趋势p <0.01）。接受AP切除术的可能性在受教育程度较低的患者和病例量较低的医院中增加。年龄较大、男性（女性与男性OR 0.71，95%CI 0.60-0.84）、未婚（OR 1.32，95%CI 1.09-1.59）或婚姻状况未知的结直肠癌患者术后住院死亡率较高。这项研究提供了证据的重要性，社会，临床和医院的特点，在一个南欧国家的公平性和医疗质量的开放式公共卫生保健系统。
The present study focuses on the analysis of social, clinical and hospital characteristics that can lead to disparities in the management and outcome of care. To that end, indicators of the quality of initial treatment delivered to newly-diagnosed colorectal cancer patients in a North-Western Region of Italy, were investigated using administrative data. The cohort includes all incident colorectal cancer patients (N = 24,187) selected by a validated algorithm from the Piedmont Hospital Discharge Record system over an 8-year period (2000–2007). Three indicators of quality of care in this population-based cohort were evaluated: the proportion of preoperative radiotherapy (RT) and of abdominoperineal (AP) resection in rectal cancer patients, and the proportion of postoperative in-hospital mortality in colorectal cancer patients. Among rectal cancers, older patients were less likely to have preoperative RT, and more likely to receive an AP resection compared to younger patients. The probability of undergoing preoperative RT and AP resection was reduced in females compared to males (odds ratio (OR) 0.77, 95% confidence interval (CI) 0.64-0.93 and OR 0.78, 95%CI 0.69-0.89, respectively). However, there was a trend of increasing RT over time (p for trend <0.01). The probability of undergoing AP resection was increased in less-educated patients and in hospitals with a low caseload. A higher risk of postoperative in-hospital mortality was found among colorectal cancer patients who were older, male, (female versus male OR 0.71, 95%CI 0.60-0.84), unmarried (OR 1.32, 95%CI 1.09-1.59) or with unknown marital status. The study provides evidence of the importance of social, clinical and hospital characteristics on the equity and quality of care in a Southern European country with an open-access public health care system.
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影响因子：
168.9
作者：
Cunningham, David;Atkin, Wendy;Starling, Naureen
通讯作者：
Starling, Naureen
影响因子：
50.5
作者：
Ciccone, G;Prastaro, C;Vineis, P
通讯作者：
Vineis, P
影响因子：
--
作者：
Bradley, Cathy J.;Given, Charles W.;Fitzgerald, Timothy L.
通讯作者：
Fitzgerald, Timothy L.
影响因子：
3
作者：
GREEN, J;WINTFELD, N
通讯作者：
WINTFELD, N
影响因子：
8.4
作者：
Jones, A. P.;Haynes, R.;Forman, D.
通讯作者：
Forman, D.