Association of travel time, patient characteristics, and hospital quality with patient mobility for breast cancer surgery: A national population-based study

被引:1
作者
Aggarwal, Ajay [1 ,2 ,9 ]
Han, Lu [1 ]
Lewis, Daniel [3 ]
Costigan, Jeanette [4 ]
Hubbard, Alison [5 ]
Taylor, Joanne [6 ]
Rigg, Anne [2 ]
Purushotham, Arnie [7 ,8 ]
van der Meulen, Jan [1 ]
机构
[1] London Sch Hyg & Trop Med, Dept Hlth Serv Res & Policy, London, England
[2] Guys & St ThomasNat Hlth Serv Fdn Trust, Dept Oncol, London, England
[3] UK Dept Environm Food & Rural Affairs, Agr Minist United Kingdom, London, England
[4] Oxford Breast Buddy Grp, Oxford, England
[5] Patient & Publ Involvement Representat, Liverpool, Merseyside, England
[6] ABC Diag, Manchester, Lancs, England
[7] Guys & St Thomas Natl Hlth Serv Fdn Trust, Dept Breast Surg, London, England
[8] Kings Coll London, Sch Canc & Pharmaceut Sci, London, England
[9] London Sch Hyg & Trop Med, Dept Hlth Serv Res & Policy, 15-17 Tavistock Pl, London WC1H 9SH, England
基金
美国国家卫生研究院;
关键词
breast cancer; geographic information systems; mastectomy; patient choice; quality indicators; waiting times; RECONSTRUCTION; CHOICE; COMPETITION; CARE;
D O I
10.1002/cncr.35153
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Background: This national study investigated hospital quality and patient factors associated with treatment location for breast cancer surgery.Methods: By using linked administrative data sets from the English National Health Service, the authors identified all women diagnosed between January 2, 2016, and December 31, 2018, who underwent breast-conserving surgery (BCS) or a mastectomy with or without immediate breast reconstruction. The extent to which patients bypassed their nearest hospital was investigated using a geographic information system (ArcGIS). Conditional logistic regressions were used to estimate the impact of travel time, hospital quality, and patient characteristics.Results: 22,622 Of 69,153 patients undergoing BCS, 22,622 (32.7%) bypassed their nearest hospital; and, of 23,536 patients undergoing mastectomy, 7179 (30.5%) bypassed their nearest hospital. Women who were younger, without comorbidities, or from rural areas were more likely to travel to more distant hospitals (p < .05). Patients undergoing BCS (odds ratio [OR], 1.85; 95% confidence interval [CI], 1.36-2.50) or mastectomy (OR, 1.52; 95% CI, 1.14-2.02) were more likely to be treated at specialist breast reconstruction centers despite not undergoing the procedure. Patients receiving mastectomy and immediate breast reconstruction were more likely to travel to hospitals employing surgeons who had a media reputation (OR, 2.41; 95% CI, 1.28-4.52). Patients undergoing BCS were less likely to travel to hospitals with shorter surgical waiting times (OR, 0.65; 95% CI, 0.46-0.92). The authors did not observe a significant impact for research activity, hospital quality rating, breast re-excision rates, or the status as a multidisciplinary cancer center.Conclusions: Patient choice policies may drive inequalities in the health care system without improving patient outcomes.
引用
收藏
页码:1221 / 1233
页数:13
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