Fushimi K, Shimizu S, Yoshii N, Kamata T, Imai H, Yamamoto K; AcademyHealth. Meeting (2005 : Boston, Mass.).
Abstr AcademyHealth Meet. 2005; 22: abstract no. 4018.
Tokyo Medical and Dental University Graduate School of Medicine, Department of Health Care Informatics, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 1138519 Tel. 81(3)5283-5788 Fax 81(3)5283-5788
RESEARCH OBJECTIVE: It has been shown that the quality of surgical care of hospitals may be associated with the volume of surgical procedures. Measures have recently been taken to increase the volume of surgical procedures in regional operation centers by Japanese government; however, the effectiveness of the measures has not been confirmed. It has been pointed out that geographic factors may prevent, especially in the rural areas, the establishment of regional operation centers to effectively provide high-quality surgical cares. The purpose of this study was to elucidate geographic, hospital, and patient factors that determine the admission to high-volume surgical hospitals or low-volume alternative ones. STUDY DESIGN: High-volume surgical hospitals for cardiac surgery, lung surgery, brain surgery, percutaneous coronary intervention (PCI) were determined as the number of the corresponding operations being 50 or greater per hospital per year according to the government guidelines. Low-volume surgical hospitals were determined as other hospitals where at least one corresponding operation was performed per year. Hospital factors were obtained from the Survey of Medical Care Institutions and patient factors were obtained from the Patient Survey operated by the Ministry of Health, Labour and Welfare of Japan in 1996, 1999, and 2002. The distances between patient residences and hospitals were determined from the location of the hospitals and the representative points of patient residence areas. Multivariable logistic regression models were used with dichotomous dependent variable for the admission to high-volume hospitals or low-volume hospitals. Independent variables were bed volume, teaching status, ownership, facilities, work force, transfer status, and distances from patient residence of admitted hospitals and of control alternative hospitals. The control alternative hospitals were determined as the nearest low-volume hospitals for the patients admitted to high-volume hospitals and as the nearest high-volume ones for the patients admitted to low-volume ones. Covariates included gender, age, outcome, and the length of stay of patients. Statistical analyses were performed by Stata/SE 8.0. POPULATION STUDIED: Records for 1387 patients with cardiac surgery, 1848 with lung surgery, 2759 with brain surgery, 12252 with PCI admitted for acute care from a nationally representative sample of 2,047,289 discharged patients from the Patient Survey were analyzed. PRINCIPAL FINDINGS: Factors in favor of admission to high-volume hospitals were transfer from other hospitals (OR=2.58, CI: 1.82-3.67), referral by physicians (OR=2.59, CI=1.82-3.67), teaching status of high-volume hospitals (OR=2.57, CI: 1.62-4.04), and private ownership (OR=1.73, CI: 1.05-2.88) of low-volume hospitals. Factors against to the admission to high-volume hospitals were distances to high-volume hospitals (OR=0.997 per km, CI: 0.995-.999). The distances to low-volume hospitals were not significant (OR=1.00). CONCLUSIONS: We found that physicians referral and teaching status contributes to induce patients to high-volume surgical hospitals and that geographic factors are statistically significant but substantial only when the high-volume hospital is very far. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: Health policy measures to promote referral to high-volume surgery hospitals and to provide information of good hospitals to patients who might choose low-volume surgery hospitals will improve the quality and efficiency of surgical care.
Publication Types:
Keywords:
- Health Services Accessibility
- Hospitals
- Humans
- Japan
- Logistic Models
- Patient Discharge
- Regression Analysis
- Thoracic Surgery
- surgery
- hsrmtgs
UI: 103623481
From Meeting Abstracts