Effect of hospital volume on processes of care and 5-year survival after breast cancer: A population-based study on 25聽000 women

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• 作者：France Vrijens^a ; ^{france.vrijens@kce.fgov.be} ; Sabine Stordeur^a ; ^c ; ^{sabine.stordeur@kce.fgov.be} ; Koen Beirens^b ; ^d ; ^{koen.beirens@kankerregister.org} ; Stephan Devriese^a ; ^c ; ^{stephan.devriese@kce.fgov.be} ; Elizabeth Van Eycken^b ; ^d ; ^{elizabeth.vaneycken@kankerregister.org} ; Joan Vlayen^a ; ^c ; ^{joan.vlayen@kce.fgov.be}
• 关键词：Breast neoplasms ; Quality indicators ; health care ; Quality insurance ; Survival analysis
• 刊名：The Breast
• 出版年：2012
• 期刊代码：321_09609776
• 类别：med
• 出版时间：June, 2012
• 卷：21
• 期：3
• 页码：261-266
• 文件大小：189 K

摘要

Purpose

To compare processes of care and survival for breast cancer by hospital volume in Belgium, based on 11 validated process quality indicators.

Methods

Three databases were linked at the patient level: the Cancer Registry, the population and the claims databases. All women with a diagnosis of invasive breast cancer between 2004 and 2006 were selected. Hospitals were classified according to their annual volume of treated patients: <50 (very low), 50-99 (low), 100-149 (medium) and 鈮?50 patients (high). Cox and logistic regression models were used to test differences in 5-year survival and in achievement of process indicators across volume categories, adjusting for age, tumor grade and stage.

Results

A total of 25聽178 women with invasive breast cancer were treated in 111 hospitals. Half of the hospitals (N聽=聽57) treated <50 patients per year. Six of eleven process indicators showed higher rates in high-volume hospitals: multidisciplinary team meeting, cytological and/or histological assessment before surgery, use of neoadjuvant chemotherapy, breast-conserving surgery rate, adjuvant radiotherapy after breast-conserving surgery, and follow-up mammography. Higher volume was also associated with improved survival. The 5-year observed survival rates were 74.9%, 78.8%, 79.8%and 83.9%for patients treated in very-low-, low-, medium- and high-volume hospitals respectively. After case-mix adjustment, patients treated in very-low- or low-volume hospitals had a hazard ratio for death of 1.26 (95%CI 1.12, 1.42) and 1.15 (95%CI 1.01, 1.30) respectively compared with high-volume hospitals.

Conclusion

Survival benefits reported in high-volume hospitals suggest a better application of recommended processes of care, justifying the centralization of breast cancer care in such hospitals.