Effect of hospital volume on processes of breast cancer care: A National Cancer Data Base study.
Effect of hospital volume on processes of breast cancer care: A National Cancer Data Base study.
复制标题
医院容量对乳腺癌护理过程的影响：国家癌症数据库研究。
DOI：
10.1002/cncr.30413
复制
发表时间：
2017
期刊：
影响因子：
6.2
通讯作者：
Nattinger,AnnB
中科院分区：
文献类型：
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作者：
Yen,TinaWF;Pezzin,LilianaE;Li,Jianing;Sparapani,Rodney;Laud,PurushuttomW;Nattinger,AnnB
BACKGROUNDThe purpose of this study was to examine variations in delivery of several breast cancer processes of care that are correlated with lower mortality and disease recurrence, and to determine the extent to which hospital volume explains this variation.METHODSWomen who were diagnosed with stage I‐III unilateral breast cancer between 2007 and 2011 were identified within the National Cancer Data Base. Multiple logistic regression models were developed to determine whether hospital volume was independently associated with each of 10 individual process of care measures addressing diagnosis and treatment, and 2 composite measures assessing appropriateness of systemic treatment (chemotherapy and hormonal therapy) and locoregional treatment (margin status and radiation therapy).RESULTSAmong 573,571 women treated at 1755 different hospitals, 38%, 51%, and 10% were treated at high‐, medium‐, and low‐volume hospitals, respectively. On multivariate analysis controlling for patient sociodemographic characteristics, treatment year and geographic location, hospital volume was a significant predictor for cancer diagnosis by initial biopsy (medium volume: odds ratio [OR] = 1.15, 95% confidence interval [CI] = 1.05‐1.25; high volume: OR = 1.30, 95% CI = 1.14‐1.49), negative surgical margins (medium volume: OR = 1.15, 95% CI = 1.06‐1.24; high volume: OR = 1.28, 95% CI = 1.13‐1.44), and appropriate locoregional treatment (medium volume: OR = 1.12, 95% CI = 1.07‐1.17; high volume: OR = 1.16, 95% CI = 1.09‐1.24).CONCLUSIONSDiagnosis of breast cancer before initial surgery, negative surgical margins and appropriate use of radiation therapy may partially explain the volume–survival relationship. Dissemination of these processes of care to a broader group of hospitals could potentially improve the overall quality of care and outcomes of breast cancer survivors.Cancer2017;123:957–66.©2016 American Cancer Society.
Фундаментални разлики между здравния и класическия мениджмънт
影响因子：
--
作者：
А. Жеков
通讯作者：
А. Жеков