Section of Health Services Research, Department of Biostatistics, Division of Quantitative Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX 77230-1402, USA.
Int J Radiat Oncol Biol Phys. 2012 Jan 1;82(1):43-50. doi: 10.1016/j.ijrobp.2010.09.025. Epub 2010 Nov 13.
To examine the association between hospital surgical volume and the use of radiation therapy (RT) after breast-conserving surgery (BCS) in Taiwan.
We used claims data from the National Health Insurance program in Taiwan (1997-2005) in this retrospective population-based study. We identified patients with breast cancer, receipt of BCS, use of radiation, and the factors that could potentially associated with the use of RT from enrollment records, and the ICD-9 and billing codes in claims. We conducted logistic regression to examine factors associated with RT use after BCS, and performed subgroup analyses to examine whether the association differs by medical center status or hospital volumes.
Among 5,094 patients with newly diagnosed invasive breast cancer who underwent BCS, the rate of RT was significantly lower in low-volume hospitals (74% vs. 82%, p < 0.01). Patients treated in low-volume hospitals were less likely to receive RT after BCS (odds ratio = 0.72, 95% confidence interval = 0.62-0.83). In addition, patients treated after the implementation of the voluntary pay-for-performance policy in 2001 were more likely to receive RT (odds ratio = 1.23; 95% confidence interval = 1.05-1.45). Subgroup analyses indicated that the high-volume effect was limited to hospitals accredited as non-medical centers, and that the effect of the pay-for-performance policy was most pronounced among low-volume hospitals.
Using population-based data from Taiwan, our study concluded that hospital surgical volume and pay-for-performance policy are positively associated with RT use after BCS.
探讨台湾地区医院手术量与保乳手术后（BCS）放疗（RT）应用的相关性。
本研究采用台湾全民健康保险计划（1997-2005 年）的理赔数据，对该回顾性基于人群的研究进行了分析。我们从入组记录中确定了患有乳腺癌、接受 BCS、使用 RT 以及可能与 RT 使用相关的因素，并利用 ICD-9 和理赔代码进行了鉴定。我们采用 logistic 回归分析了与 BCS 后 RT 使用相关的因素，并进行了亚组分析，以检验医院规模和手术量是否对 RT 使用的相关性产生影响。
在 5094 例新诊断为浸润性乳腺癌并接受 BCS 的患者中，低容量医院的 RT 使用率明显较低（74% vs. 82%，p < 0.01）。低容量医院治疗的患者接受 BCS 后接受 RT 的可能性较小（比值比=0.72，95%置信区间=0.62-0.83）。此外，在 2001 年实施自愿按绩效付费政策后治疗的患者更有可能接受 RT（比值比=1.23；95%置信区间=1.05-1.45）。亚组分析表明，大容量效应仅限于未被认证为医学中心的医院，而按绩效付费政策的效果在低容量医院中最为显著。
本研究使用来自台湾的基于人群的数据，得出的结论是医院手术量和按绩效付费政策与 BCS 后 RT 的使用呈正相关。
