Improving survival and local control in rectal cancer in Catalonia (Spain) in the context of centralisation: A full cycle audit assessment
Por:
Manchon-Walsh, P, Aliste, L, Espinas, JA, Prades, J, Guarga, A, Balart, J, Biondo, S, Castells, A, Sanjuan, X, Tabernero, J, Borras, JM
Publicada:
1 dic 2016
Resumen:
Background: Rectal cancer surgery in Catalonia has been involved in a process of centralisation. We assessed the impact of this health policy strategy on quality of care and clinical results.
Methods: We compared patterns of care and clinical outcomes of all rectal cancer patients receiving radical surgery for the first time in public hospitals in two time periods, before (2005 and 2007) and after (2011-2012) centralisation, analysing indicators of care quality according to the regional clinical practice guidelines. Clinical outcomes at two years were also assessed.
Results: A total of 3780 patients were included. From 2005 to 2012, the proportion of patients treated surgically for the first time in centres whose annual surgical caseload was more than 11 increased from 84.0% to 90.4%. The rate of locoregional recurrence at two years fell from 4.5 to 3.06/100 person-years (p = 0.005). The crude mortality rate at three months, one and two years was reduced by 55%, 40% and 34% (p < 0.001).
Conclusion: Improvements in quality of care might be associated with the centralisation of surgery and with the selective focus effect derived from the process of auditing. Our results support the continuation of clinical auditing and surveillance of authorised centres. (C) 2016 Elsevier Ltd, BASO - The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
Filiaciones:
Manchon-Walsh, P:
Govt Catalonia, Dept Hlth, Catalonian Canc Strategy, Avd Gran Via Hosp 199-203, Barcelona 08908, Spain
Univ Barcelona, Dept Clin Sci, Biomed Res Inst Bellvitge IDIBELL, C Feixa Llarga S-N, Barcelona 08907, Spain
Aliste, L:
Govt Catalonia, Dept Hlth, Catalonian Canc Strategy, Avd Gran Via Hosp 199-203, Barcelona 08908, Spain
Univ Barcelona, Dept Clin Sci, Biomed Res Inst Bellvitge IDIBELL, C Feixa Llarga S-N, Barcelona 08907, Spain
Espinas, JA:
Govt Catalonia, Dept Hlth, Catalonian Canc Strategy, Avd Gran Via Hosp 199-203, Barcelona 08908, Spain
Univ Barcelona, Dept Clin Sci, Biomed Res Inst Bellvitge IDIBELL, C Feixa Llarga S-N, Barcelona 08907, Spain
Prades, J:
Govt Catalonia, Dept Hlth, Catalonian Canc Strategy, Avd Gran Via Hosp 199-203, Barcelona 08908, Spain
Univ Barcelona, Dept Clin Sci, Biomed Res Inst Bellvitge IDIBELL, C Feixa Llarga S-N, Barcelona 08907, Spain
Guarga, A:
Catalonian Hlth Serv CatSalut, Hlth Serv Procurement & Assessment, Travessera Corts 131-159, Barcelona 08028, Spain
Balart, J:
Hosp Santa Creu & Sant Pau, Dept Radiat Oncol, C St Quinti 89, Barcelona 08026, Spain
Biondo, S:
Univ Hosp Bellvitge, Dept Gen & Digest Surg, C Feixa Llarga S-N, Barcelona 08907, Spain
Castells, A:
Clin Univ Hosp, Dept Gastroenterol, C Villarroel 170, Barcelona 08036, Spain
Sanjuan, X:
Univ Hosp Bellvitge, Dept Pathol, C Feixa Llarga S-N, Barcelona 08907, Spain
Tabernero, J:
Vall dHebron Univ Hosp, VHIO, Dept Med Oncol, Po de la dHebron 119-129, Barcelona 08035, Spain
Borras, JM:
Govt Catalonia, Dept Hlth, Catalonian Canc Strategy, Avd Gran Via Hosp 199-203, Barcelona 08908, Spain
Univ Barcelona, Dept Clin Sci, Biomed Res Inst Bellvitge IDIBELL, C Feixa Llarga S-N, Barcelona 08907, Spain
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