Can postoperative process of care utilization or complication rates explain the volume-cost relationship for cancer surgery?
Can postoperative process of care utilization or complication rates explain the volume-cost relationship for cancer surgery?
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DOI：
10.1016/j.surg.2017.03.004
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发表时间：
2017-08
期刊：
影响因子：
3.8
通讯作者：
Aloia TA
中科院分区：
文献类型：
--
作者：
Ho V;Short MN;Aloia TA
过去的研究确定了供应商数量和结果之间的关联，但对癌症手术的数量-成本关系知之甚少。我们分析了六种癌症手术的量-成本关系，并探讨了它是否受到并发症的发生和/或护理过程的利用率的影响。分析了2005年至2009年6种癌症切除术的医疗保险医院和住院患者索赔：结肠切除术、直肠切除术、肺叶切除术、肺切除术、食管切除术和胰腺切除术。回归首先估计量化的供应商量与成本的关联，不包括并发症和护理过程的措施作为解释变量。接下来，这些变量被添加到回归中，以测试它们是否削弱了先前观察到的数量-成本关系。较高的住院量与较低的食管切除术患者成本相关，但与其他手术无关。更高的外科医生数量降低了大多数手术的成本，但当护理过程被添加到回归中时，这一结果就会减弱。经常针对不良事件实施的护理过程与14%至34%的成本增加有关。这些过程的使用在低手术量与高手术量的外科医生中更为普遍。并发症发生时实施的护理过程解释了外科医生的量-成本关系。考虑到外科医生的数量很容易观察到，通过将患者转诊给高手术量的外科医生，可以实现更好的结果和更低的成本。增加患者接触外科医生的机会，降低并发症的发生率，可能是避免昂贵的护理过程，控制支出增长的最有效策略。
Past studies identify an association between provider volume and outcomes, but less is known about the volume-cost relationship for cancer surgery. We analyze the volume-cost relationship for six cancer operations and explore whether it is influenced by the occurrence of complications and/or utilization of processes of care. Medicare hospital and inpatient claims for the years 2005 through 2009 were analyzed for 6 cancer resections: colectomy, rectal resection, pulmonary lobectomy, pneumonectomy, esophagectomy, and pancreatic resection. Regressions were first estimated to quantify the association of provider volume with costs, excluding measures of complications and processes of care as explanatory variables. Next, these variables were added to the regressions to test whether they weakened any previously observed volume-cost relationship. Higher hospital volume is associated with lower patient costs for esophagectomy, but not for other operations. Higher surgeon volume reduces costs for most procedures, but this result weakens when processes of care are added to the regressions. Processes of care that are frequently implemented in response to adverse events are associated with 14 to 34 percent higher costs. Utilization of these processes is more prevalent among low-volume versus high-volume surgeons. Processes of care implemented when complications occur explain much of the surgeon volume-cost relationship. Given that surgeon volume is readily observed, better outcomes and lower costs may be achieved by referring patients to high-volume surgeons. Increasing patient access to surgeons with lower rates of complications may be the most effective strategy for avoiding costly processes of care, controlling expenditure growth.
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