Cost and Quality of Cancer Surgery

描述(由申请者提供)：这个项目旨在促进我们对提供者数量与癌症手术的成本和质量之间的联系的理解。以前的研究发现，每年进行更多癌症手术的外科医生和医院的手术死亡率较低(9-13)。这种关系存在于复杂的手术，如胰腺切除术，以及更常见的手术，如结肠切除术。我们最近发表的一项研究发现，相对于小容量外科医生，大容量外科医生的治疗与六种不同癌症切除的每位患者的医院费用较低相关。然而，较高的住院量与较低的住院费用有关，只有一种手术，即结肠切除术(14)。该项目试图通过回答以下问题来确定这些发现的潜在原因：1)提供者数量与医生和医院成本之间的关联是什么，分别或合并？2)哪些因素与大容量外科医生的成本较低相关？3)哪些因素决定医院的成本？4)医疗保险报销与低容量和大容量医院的成本之间的差异是什么？医院利润是否因供应商数量状况而异？5)外科医生/医院成本较低的因素是否也与患者死亡率较低相关？这一结果对确定提供癌症手术的经济有效的方法具有重要意义。这些分析将阐明，将患者转介给大容量供应商、降低DRG报销率以阻止低数量供应商，或者传播最佳实践而不考虑数量是否可以抑制成本增长并改善患者结果。 公共卫生相关性：了解为什么医院和外科医生进行的癌症手术数量与患者护理成本相关，将使我们能够确定集中复杂的癌症手术是否将抑制癌症护理成本的上升。此外，我们对哪些护理过程或其他因素影响患者成本的了解相对较少。通过确定这些因素中的一些因素，我们将提供能够指导努力实现过程改进的知识，从而既改善患者护理又节省成本。

DESCRIPTION (provided by applicant): This project aims to advance our understanding of the association between provider volume, and the costs and quality of cancer surgery. Previous studies have found that surgeons and hospitals that perform more cancer operations per year have lower operative mortality rates (9-13). This relationship exists for complex operations such as pancreatic resection, and for more commonly performed procedures such as colectomy. We recently published a study that found that relative to low-volume surgeons, treatment by high-volume surgeons was associated with lower per-patient hospital costs for six different cancer resections. However, high hospital volume was associated with lower hospitals costs for only one procedure, colectomy (14). This project seeks to determine the underlying reasons for these findings by answering the following questions: 1) What is the association between provider volume and both physician and hospital costs, separately and combined? 2) What are the factors that are associated with lower costs for high-volume surgeons? 3) What factors determine costs for hospitals? 4) What is the differential between Medicare reimbursement and costs for low and high volume hospitals? Does hospital profit vary by provider volume status? 5) Are the factors associated with lower costs for surgeons/hospitals also correlated with lower mortality rates for patients? The results have important implications for identifying cost-effective approaches to providing cancer surgery. The analyses will shed light on whether referring patients to high-volume providers, lowering DRG reimbursement rates to discourage low-volume providers, or dissemination of best practices irrespective of volume could restrain cost growth and improve patient outcomes. PUBLIC HEALTH RELEVANCE: Gaining insights on why the number of cancer operations that hospitals and surgeons perform is associated with the costs of patient care will enable us to determine whether centralizing complex cancer operations will restrain the rising costs of cancer care. Moreover, we know relatively little about which processes of care or other factors influence patient costs. By identifying some of these factors, we will provide knowledge which can guide efforts to achieve process improvement that will both improve patient care and save costs.