Disparities in utilization of high-volume hospitals for cancer surgery

Results of a Korean population-based study

So Young Kim, Jong Hyock Park, Sung Gyeong Kim, Hye Kyung Woo, Jae Hyun Park, Yoon Kim, Eun Cheol Park

Research output: Contribution to journalArticleResearchpeer-review

13 Citations (Scopus)

Abstract

Background: Referral to high-volume hospitals has been recommended for cancer procedures with a demonstrated volume-outcome relationship. However, little is known about the factors associated with use of high-volume hospitals for cancer procedures. The purpose of this study was to determine patient characteristics associated with receipt of oncologic surgery at high-volume hospitals. Methods: Data were obtained from claims submitted to the Korean National Health Insurance System. We identified patients who underwent the following procedures between 2002 and 2005: esophagectomy, pancreatectomy, gastrectomy, colectomy, lung resection, mastectomy, and cystectomy. Each hospital volume was divided into tertiles. Patient demographic, socioeconomic, and clinical variables were investigated as factors that may affect use of high- or low-volume hospitals. Results: A total of 49,897 patients received one of the seven procedures. Trends toward lower operative risks at high-volume hospitals were observed for all procedures. Patients who were older [odds ratio (OR), 0.60-0.69], lived in a rural area (OR, 0.79), had emergent surgeries (OR, 0.39-0.85), and had lower Charlson score were less likely to go to high-volume hospitals. For all procedures, patients having the lowest income level were significantly less likely to be treated at high-volume hospitals, compared with patients having the highest income level (OR, 0.45-0.58). Conclusions: We identified substantial demographic and socioeconomic disparities in use of high-volume hospitals for the seven procedures examined. The policy for selective referral to high-volume hospitals should include explicit efforts to identify patient and system factors required to reduce current inequities.

Original languageEnglish
Pages (from-to)2806-2815
Number of pages10
JournalAnnals of Surgical Oncology
Volume17
Issue number11
DOIs
StatePublished - 1 Nov 2010

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High-Volume Hospitals
Population
Neoplasms
Odds Ratio
Referral and Consultation
Low-Volume Hospitals
Demography
Pancreatectomy
Esophagectomy
Colectomy
Cystectomy
Mastectomy
National Health Programs
Gastrectomy
Lung

Cite this

Kim, So Young ; Park, Jong Hyock ; Kim, Sung Gyeong ; Woo, Hye Kyung ; Park, Jae Hyun ; Kim, Yoon ; Park, Eun Cheol. / Disparities in utilization of high-volume hospitals for cancer surgery : Results of a Korean population-based study. In: Annals of Surgical Oncology. 2010 ; Vol. 17, No. 11. pp. 2806-2815.
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title = "Disparities in utilization of high-volume hospitals for cancer surgery: Results of a Korean population-based study",
abstract = "Background: Referral to high-volume hospitals has been recommended for cancer procedures with a demonstrated volume-outcome relationship. However, little is known about the factors associated with use of high-volume hospitals for cancer procedures. The purpose of this study was to determine patient characteristics associated with receipt of oncologic surgery at high-volume hospitals. Methods: Data were obtained from claims submitted to the Korean National Health Insurance System. We identified patients who underwent the following procedures between 2002 and 2005: esophagectomy, pancreatectomy, gastrectomy, colectomy, lung resection, mastectomy, and cystectomy. Each hospital volume was divided into tertiles. Patient demographic, socioeconomic, and clinical variables were investigated as factors that may affect use of high- or low-volume hospitals. Results: A total of 49,897 patients received one of the seven procedures. Trends toward lower operative risks at high-volume hospitals were observed for all procedures. Patients who were older [odds ratio (OR), 0.60-0.69], lived in a rural area (OR, 0.79), had emergent surgeries (OR, 0.39-0.85), and had lower Charlson score were less likely to go to high-volume hospitals. For all procedures, patients having the lowest income level were significantly less likely to be treated at high-volume hospitals, compared with patients having the highest income level (OR, 0.45-0.58). Conclusions: We identified substantial demographic and socioeconomic disparities in use of high-volume hospitals for the seven procedures examined. The policy for selective referral to high-volume hospitals should include explicit efforts to identify patient and system factors required to reduce current inequities.",
author = "Kim, {So Young} and Park, {Jong Hyock} and Kim, {Sung Gyeong} and Woo, {Hye Kyung} and Park, {Jae Hyun} and Yoon Kim and Park, {Eun Cheol}",
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Disparities in utilization of high-volume hospitals for cancer surgery : Results of a Korean population-based study. / Kim, So Young; Park, Jong Hyock; Kim, Sung Gyeong; Woo, Hye Kyung; Park, Jae Hyun; Kim, Yoon; Park, Eun Cheol.

In: Annals of Surgical Oncology, Vol. 17, No. 11, 01.11.2010, p. 2806-2815.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Disparities in utilization of high-volume hospitals for cancer surgery

T2 - Results of a Korean population-based study

AU - Kim, So Young

AU - Park, Jong Hyock

AU - Kim, Sung Gyeong

AU - Woo, Hye Kyung

AU - Park, Jae Hyun

AU - Kim, Yoon

AU - Park, Eun Cheol

PY - 2010/11/1

Y1 - 2010/11/1

N2 - Background: Referral to high-volume hospitals has been recommended for cancer procedures with a demonstrated volume-outcome relationship. However, little is known about the factors associated with use of high-volume hospitals for cancer procedures. The purpose of this study was to determine patient characteristics associated with receipt of oncologic surgery at high-volume hospitals. Methods: Data were obtained from claims submitted to the Korean National Health Insurance System. We identified patients who underwent the following procedures between 2002 and 2005: esophagectomy, pancreatectomy, gastrectomy, colectomy, lung resection, mastectomy, and cystectomy. Each hospital volume was divided into tertiles. Patient demographic, socioeconomic, and clinical variables were investigated as factors that may affect use of high- or low-volume hospitals. Results: A total of 49,897 patients received one of the seven procedures. Trends toward lower operative risks at high-volume hospitals were observed for all procedures. Patients who were older [odds ratio (OR), 0.60-0.69], lived in a rural area (OR, 0.79), had emergent surgeries (OR, 0.39-0.85), and had lower Charlson score were less likely to go to high-volume hospitals. For all procedures, patients having the lowest income level were significantly less likely to be treated at high-volume hospitals, compared with patients having the highest income level (OR, 0.45-0.58). Conclusions: We identified substantial demographic and socioeconomic disparities in use of high-volume hospitals for the seven procedures examined. The policy for selective referral to high-volume hospitals should include explicit efforts to identify patient and system factors required to reduce current inequities.

AB - Background: Referral to high-volume hospitals has been recommended for cancer procedures with a demonstrated volume-outcome relationship. However, little is known about the factors associated with use of high-volume hospitals for cancer procedures. The purpose of this study was to determine patient characteristics associated with receipt of oncologic surgery at high-volume hospitals. Methods: Data were obtained from claims submitted to the Korean National Health Insurance System. We identified patients who underwent the following procedures between 2002 and 2005: esophagectomy, pancreatectomy, gastrectomy, colectomy, lung resection, mastectomy, and cystectomy. Each hospital volume was divided into tertiles. Patient demographic, socioeconomic, and clinical variables were investigated as factors that may affect use of high- or low-volume hospitals. Results: A total of 49,897 patients received one of the seven procedures. Trends toward lower operative risks at high-volume hospitals were observed for all procedures. Patients who were older [odds ratio (OR), 0.60-0.69], lived in a rural area (OR, 0.79), had emergent surgeries (OR, 0.39-0.85), and had lower Charlson score were less likely to go to high-volume hospitals. For all procedures, patients having the lowest income level were significantly less likely to be treated at high-volume hospitals, compared with patients having the highest income level (OR, 0.45-0.58). Conclusions: We identified substantial demographic and socioeconomic disparities in use of high-volume hospitals for the seven procedures examined. The policy for selective referral to high-volume hospitals should include explicit efforts to identify patient and system factors required to reduce current inequities.

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U2 - 10.1245/s10434-010-1133-x

DO - 10.1245/s10434-010-1133-x

M3 - Article

VL - 17

SP - 2806

EP - 2815

JO - Annals of surgical oncology

JF - Annals of surgical oncology

SN - 1068-9265

IS - 11

ER -