How do family doctors respond to reduced waiting times for cancer diagnosis in secondary care?
How do family doctors respond to reduced waiting times for cancer diagnosis in secondary care?
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DOI：
10.1007/s10198-023-01626-2
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发表时间：
2023-10
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影响因子：
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通讯作者：
H. Hayes;R. Meacock;Jonathan Stokes;Matt Sutton
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文献类型：
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作者：
H. Hayes;R. Meacock;Jonathan Stokes;Matt Sutton
减少等待时间是公共卫生系统的一个优先事项。如果医疗服务提供者缩短等待时间的努力同时导致需求大幅增加，那么这些努力可能会被否定。然而，要区分供求变化对等候时间的影响，需要一个要素发生外生变化。我们研究了一些英国医院的试点计划的影响，以缩短家庭医生转诊的疑似癌症紧急诊断的等待时间。我们调查了2012年4月1日至2019年3月31日期间6，666家家庭医生合作伙伴向145家医院的转诊情况。2017年，五家医院试行了缩短候诊时间的举措。使用连续差分差分回归，我们利用试点作为“供应移位器”来估计两种可疑癌症类型的转诊量的等待时间的影响：肠和肺。根据该政策，在试点医院，因疑似肠癌而违反两周等待时间目标的转诊患者比例从基线的4.8%下降了3.9个百分点。接触试点的家庭医生的转诊（需求）增加了10.8%。然而，该试点在肺癌方面并不成功，有证据表明等待时间增加，转诊率相应减少了-10.5%。家庭医生对疑似癌症的转诊在等待时间的边际上是有反应的。如果供应方面的改善被需求的增加所抵消，医疗保健提供者可能很难实现等待时间的长期减少。
Reducing waiting times is a priority in public health systems. Efforts of healthcare providers to shorten waiting times could be negated if they simultaneously induce substantial increases in demand. However, separating out the effects of changes in supply and demand on waiting times requires an exogenous change in one element. We examine the impact of a pilot programme in some English hospitals to shorten waiting times for urgent diagnosis of suspected cancer on family doctors’ referrals. We examine referrals from 6,666 family doctor partnerships to 145 hospitals between 1st April 2012 and 31st March 2019. Five hospitals piloted shorter waiting times initiatives in 2017. Using continuous difference-in-differences regression, we exploit the pilot as a ‘supply shifter’ to estimate the effect of waiting times on referral volumes for two suspected cancer types: bowel and lung. The proportion of referred patients breaching two-week waiting times targets for suspected bowel cancer fell by 3.9 percentage points in pilot hospitals in response to the policy, from a baseline of 4.8%. Family doctors exposed to the pilot increased their referrals (demand) by 10.8%. However, the pilot was not successful for lung cancer, with some evidence that waiting times increased, and a corresponding reduction in referrals of −10.5%. Family doctor referrals for suspected cancer are responsive at the margin to waiting times. Healthcare providers may struggle to achieve long-term reductions in waiting times if supply-side improvements are offset by increases in demand.