Relationship among the Hospital/Physician’s Characteristics, Process of Care and Outcome in Curative Therapies for Patients with Hepatocellular Carcinoma

Background
Hepatocellular carcinoma (HCC) is the second death cause of cancer in Taiwan, and its incidence is increasing worldwide. The volume-outcome relationship has been established for several complex disease treatments including cancer care. However, few studies have examined the relationships between the pattern of care measured by HCC core measure indicators and hospital/physician volume-outcome relationship for patients received HCC curative therapies.
Purpose
The study has examined the associations among hospital/physician characteristics, the pattern of care, and outcomes for patients with HCC via national databases.
Method
A retrospective cohort study was conducted of 2,114 HCC patients received curative therapies that had registry in Taiwan Cancer Database (TCDB) in 2004. The 2,114 patients were received care from 29 hospitals, and 1,548 patients were treated by 275 physicians. Also their three-year National Health Insurance claims data and three-year survivals were collected from respectively National Health Research Institute and death cause database of Department of Health. Relationships between hospital/physician volume characteristics, pattern of care, and 1-year/3-year survivals were assessed by X2, ANOVA, Log-rank test, and the associations among variables were assessed by multiple regression, logistic regression, and Cox proportional hazard regressions with accounting for potentially confounding patient characteristics.
Results
Hospital characteristics (including ownership, accreditation level, geography, and 3-year service volume), physician characteristics (including specialty) were identified to be significantly related to the pattern of care and outcomes of patients with HCC.
Conclusion
Both hospital and physician characteristics are significantly related to survival outcome for patients with HCC. Besides, the diagnosis of pattern are also significantly related to 3-year survival outcome for patients with HCC.