Adult urologyVolume, Process of Care, and Operative Mortality for Cystectomy for Bladder Cancer
Section snippets
Subjects
Incident bladder cancer cases diagnosed from 1992 to 1999 in patients aged 65 to 99 years were identified from the Surveillance, Epidemiology, and End Results (SEER)-Medicare files. The demographic composition, as well as the cancer incidence and mortality trends, of the SEER registry is considered representative of the entire U.S. population.10 For each Medicare patient within SEER, the SEER-Medicare linked files contain 100% of inpatient (part A) and outpatient and physician (part B) claims.
Results
From 1992 to 1999, 4465 patients were treated with partial (n = 1375, 30.8%) or radical (n = 3090, 69.2%) cystectomy for bladder cancer within the SEER-Medicare database. Differences in patient characteristics for low, medium, and high-volume hospitals are given in Table 1. In general, high-volume hospitals treated a slightly younger patient population and a greater proportion of blacks. Although patients had a similar cancer stage distribution across the hospital volume strata, those treated
Comment
After adjusting for differences in health status and disease severity, patients treated at low-volume hospitals were nearly 50% more likely to die in the postoperative period. We observed substantial disparities in the use of processes of care by hospital volume for all phases of patient care. With regard to most processes, high-volume hospitals had substantially greater rates of use, exhibiting a more intensive practice style overall. Cumulatively, these processes had a moderate effect in
Conclusions
This study is among the first to suggest differences in processes of care according to hospital volume. These differences explain some, but not all, of the volume-mortality effect among patients undergoing cystectomy for bladder cancer. Ultimately, the exportation of processes of care identified at high-volume to low-volume hospitals might be the most practical means of reducing the variation in mortality rates across hospitals.
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Cited by (0)
The views expressed herein do not necessarily represent the views of Center for Medicare and Medicaid Services or the United States Government.
This study was supported by the National Cancer Institute (1 R01 CA098481-01A1).