Re-examining the significance of surgical volume to breast cancer survival and recurrence versus process quality of care in Taiwan
Resource
Health Serv. Res., 48(1), 26-46
Journal
Health Services Research
Journal Volume
48
Journal Issue
1
Pages
26-46
Date Issued
2013
Author(s)
Abstract
Objective. This study explored the association of surgical volume versus process quality with breast cancer survival and recurrence. Data Sources/Study Setting Population-based cancer registration data and National Health Insurance claim data. Study Design This population-based study linked Taiwan's Cancer Database with Taiwan's National Health Insurance Database to collect data on all patients diagnosed with breast cancer in 2003-2004 who received surgical treatment. Principal Findings This study included 6,396 female breast cancer patients, reported by 26 hospitals. After controlling for patient and provider characteristics, Cox's regression models did not reveal any association between a physician's surgical volume and breast cancer recurrence or survival, although hospital volume was marginally associated with positive 5-year recurrence (HR: 1.001, 95%CI: 1.000, 1.001). After controlling for hospital or physician volume of surgery, we found a significant association between quality of care and both 5-year survival and recurrence. Random effects were also identified between patients and providers based on 5-year survival and 5-year recurrence. Conclusions Process quality of care was significantly more related to survival or recurrence than to surgical volume. The random effects found within hospital-patient clustered data indicated that the effect of the clustered feature of this data should be considered when performing volume-outcome related studies. ? Health Research and Educational Trust.
Subjects
breast cancer; multilevel analysis; Quality of care; survival analysis; volume-outcome relationship
SDGs
Other Subjects
adult; article; breast cancer; breast surgery; cancer mortality; cancer patient; cancer recurrence; cancer registry; cancer staging; cancer surgery; cancer survival; comorbidity; disease severity; female; health care quality; hospital patient; human; major clinical study; overall survival; partial mastectomy; recurrence risk; survival time; Taiwan; treatment outcome; Adult; Age Factors; Aged; Breast Neoplasms; Comorbidity; Female; Hospital Administration; Humans; Middle Aged; Neoplasm Recurrence, Local; Neoplasm Staging; Outcome and Process Assessment (Health Care); Proportional Hazards Models; Quality of Health Care; Registries; Survival Analysis; Taiwan
Type
journal article
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