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Associations of centralization with health care quality for gastric cancer patients receiving gastrectomy in China

Chinese Journal of Cancer Research 2021年第6期33卷 659-670页

作者： Jiafu Ji Leiyu Shi Xiangji Ying Xinpu Lu Fei Shan Haibo Wang Key Laboratory of Carcinogenesis and Translational Research(Ministry of Education/Beijing) Center of Gastrointestinal CancerPeking University Cancer Hospital&InstituteBeijing 100142China Department of Health Policy and Management Johns Hopkins University Bloomberg School of Public HealthBaltimoreMD 21205USA Key Laboratory of Carcinogenesis and Translational Research(Ministry7 of Education/Beijing) Peking University Cancer Hospital&InstituteBeijing 100142China Clinical Trial Unit the First Affiliated Hospital of Sun Yat-sen UniversityGuangzhou 510080China

Objective:Limited evidence is available regarding the associations of centralization with gastric cancer patients’quality of care in high surgical volume *** current study aimed to explore the effects of hospital volume and the herfindahl-hirschman index(HHI)on in-hospital mortality,total cost,and length of stay for Chinese gastrectomy patients in a nationwide ***:We extracted data on gastrectomy for gastric cancer from the Hospital Quality Monitoring System Database between 2013 and *** volume was divided into 4 quartiles:low(1-83 cases per year),medium(84-238 cases),high(239-579 cases),and very high(580-1,193 cases).The HHI was divided into 3 categories:highly concentrated(>2,500),moderately concentrated(1,500-2,500),and unconcentrated(<1,500).We used mixed-effects models to analyze the data while accounting for data ***:We analyzed 125,683 patients in 515 *** the multivariable analyses,hospital volume was significantly associated with in-hospital mortality[medium ***:odds ratio(OR)=0.61,95%confidence interval(95%CI)=0.43-0.84,P=0.003;high:OR=0.57,95%CI=0.38-0.87,P=0.009;and very high:OR=0.33,95%CI=0.18-0.61,P<0.001)and length of stay(high ***:β=-0.036,95%CI=-0.071--0.002,P=0.039)but not with total *** located in unconcentrated provinces had higher in-hospital mortality(OR=1.52,95%CI=1.03-2.26,P=0.036)and longer lengths of stay(β=0.024,95%CI=0.001-0.047,P=0.041)than hospitals located in highly concentrated ***:Centralization of gastrectomy,measured by hospital volume and the HHI,was associated with decreased in-hospital mortality and shortened length of stay without increasing total *** results support the strategy of centralizing gastrectomy in high-volume settings.

关键词： Centralization gastric cancer herfindahl-hirschman index hospital volume quality of care

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