Impact of patient choice and hospital competition on patient outcomes after prostate cancer surgery: A national population‐based study

Aggarwal, Ajay; Sujenthiran, Arunan; Lewis, Daniel; Walker, Kate; Cathcart, Paul; Clarke, Noel W.; Sullivan, Richard; Meulen, Jan van der

doi:10.1002/cncr.31987

Cited by 15 publications

(16 citation statements)

References 33 publications

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“…Geographic level factors consisted of median household income (reported by quartiles of the patient's ZIP code and acquired from AHRF), Herfindahl-Hirschman index (defined as the sum of square market shares of inpatient days measured in a county, 34 which was obtained from AHA survey), and state-fixed effects. 35,36…”

Section: Covariatesmentioning

confidence: 99%

<p>Multi-morbidities are Not a Driving Factor for an Increase of COPD-Related 30-Day Readmission Risk</p>

Lin

Xue

Deng

et al. 2020

COPD

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Background and Objective: Chronic obstructive pulmonary disease (COPD) is the third leading cause of death in the United States. COPD is expensive to treat, whereas the quality of care is difficult to evaluate due to the high prevalence of multi-morbidity among COPD patients. In the US, the Hospital Readmissions Reduction Program (HRRP) was initiated by the Centers for Medicare and Medicaid Services to penalize hospitals for excessive 30-day readmission rates for six diseases, including COPD. This study examines the difference in 30-day readmission risk between COPD patients with and without comorbidities. Methods: In this retrospective cohort study, we used Cox regression to estimate the hazard ratio of 30-day readmission rates for COPD patients who had no comorbidity and those who had one, two or three, or four or more comorbidities. We controlled for individual, hospital and geographic factors. Data came from three sources: Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID), Area Health Resources Files (AHRF) and the American Hospital Association's (AHA's) annual survey database for the year of 2013. Results: COPD patients with comorbidities were less likely to be readmitted within 30 days relative to patients without comorbidities (aHR from 0.84 to 0.87, p < 0.05). In a stratified analysis, female patients with one comorbidity had a lower risk of 30-day readmission compared to female patients without comorbidity (aHR = 0.80, p < 0.05). Patients with public insurance who had comorbidities were less likely to be readmitted within 30 days in comparison with those who had no comorbidity (aHR from 0.79 to 0.84, p < 0.05). Conclusion: COPD patients with comorbidities had a lower risk of 30-day readmission compared with patients without comorbidity. Future research could use a different study design to identify the effectiveness of the HRRP.

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Section: Covariatesmentioning

confidence: 99%

<p>Multi-morbidities are Not a Driving Factor for an Increase of COPD-Related 30-Day Readmission Risk</p>

Lin

Xue

Deng

et al. 2020

COPD

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“…The authors noted that patient mobility occurred in the absence of validated measures of care quality and concluded that competition between hospital trusts for patients may be creating disparities in access to care. Nevertheless, in a separate study by the same team using data from 2008 to 2011, it was noted that competition appeared to improve short-term patient outcomes [23]. Both studies predate our present data collection period, and it is possible that the more widespread availability of RARP has helped reduce the desire to bypass local providers, and thus the disparities in access and outcomes reported in the earlier studies.…”

Section: Discussionmentioning

confidence: 69%

An observational study of volume–outcome effects for robot‐assisted radical prostatectomy in England

Gray¹,

Day²,

Briggs

et al. 2021

BJU International

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To investigate volume-outcome relationships in robot-assisted radical prostatectomy (RARP) for cancer using data from the Hospital Episodes Statistics (HES) database for England. Materials and MethodsData for all adult, elective RPs for cancer during the period January 2013-December 2018 (inclusive) were extracted from the HES database. The HES database records data on all National Health Service (NHS) hospital admissions in England. Data were extracted for the NHS trust and surgeon undertaking the procedure, the surgical technique used (laparoscopic, open or robot-assisted), hospital length of stay (LOS), emergency readmissions, and deaths. Multilevel modelling was used to adjust for hierarchy and covariates. ResultsData were available for 35 629 RPs (27 945 RARPs). The proportion of procedures conducted as RARPs increased from 53.2% in 2013 to 92.6% in 2018. For RARP, there was a significant relationship between 90-day emergency hospital readmission (primary outcome) and trust volume (odds ratio [OR] for volume decrease of 10 procedures: 0.99, 95% confidence interval [CI] 0.99-1.00; P = 0.037) and surgeon volume (OR for volume decrease of 10 procedures: 0.99, 95% CI 0.99-1.00; P = 0.013) in the previous year. From lowest to highest volume category there was a decline in the adjusted proportion of patients readmitted as an emergency at 90 days from 10.6% (0-49 procedures) to 7.0% (≥300 procedures) for trusts and from 9.4% (0-9 procedures) to 8.3% (≥100 procedures) for surgeons. LOS was also significantly associated with surgeon and trust volume, although 1-year mortality was associated with neither. ConclusionsThere is evidence of a volume-outcome relationship for RARP in England and minimising low-volume RARP will improve patient outcomes. Nevertheless, the observed effect size was relatively modest, and stakeholders should be realistic when evaluating the likely impact of further centralisation at a population level.

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“…It is also notable that we found no published articles focusing on how the reform has affected costs, efficiency and continuity. A lack of evidence of improved efficiency and quality as a result of patient choice has previously been noted [ 63 ], but some studies have indicated a positive effect of competition on quality in specialised care [ 64 , 65 ].…”

Section: Discussionmentioning

confidence: 99%

Fifteen years with patient choice and free establishment in Swedish primary healthcare: what do we know?

Fredriksson

Isaksson

2022

Scand J Public Health

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Background: In 2007, a reform of Swedish primary healthcare began when some regions implemented enhanced patient choice in combination with free establishment for private providers. Although heavily debated, in 2010 it became mandatory for all regions to implement this choice system. Aim: The aim of this article was to review all published research articles related to the primary healthcare choice reform in Sweden, to investigate what has been published about the reform and summarise its first 15 years. Methods: A scoping review was performed to cover the breadth of research on the reform. Searches were made in Scopus, Web of Science and PubMed for articles published between 2007 and 2021, resulting in 217 unique articles. In total, 52 articles were included. Results: The articles were summarised and presented in relation to six overarching themes: arguments about the primary healthcare choice reform; governance and financial reimbursements; choice of provider and use of information; effects on equity and access; effects on quality; and differences between private and public primary healthcare centres. Conclusions: The articles show that the reform has led to an increase in access to primary healthcare, but most studies indicate that the increase is inequitably distributed in terms of socioeconomy and geographical location. The effects on quality are unclear but several studies show that the mechanisms supposed to lead to quality improvements do not work as intended. Furthermore, from a population health perspective, it is time to discuss how such a responsibility can be reintegrated into primary healthcare and function with the choice system.

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Impact of patient choice and hospital competition on patient outcomes after prostate cancer surgery: A national population‐based study

Cited by 15 publications

References 33 publications

<p>Multi-morbidities are Not a Driving Factor for an Increase of COPD-Related 30-Day Readmission Risk</p>

<p>Multi-morbidities are Not a Driving Factor for an Increase of COPD-Related 30-Day Readmission Risk</p>

An observational study of volume–outcome effects for robot‐assisted radical prostatectomy in England

Fifteen years with patient choice and free establishment in Swedish primary healthcare: what do we know?

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