Department of Urology, University of Washington, Seattle, Washington.
Cancer. 2014 May 15;120(10):1565-71. doi: 10.1002/cncr.28616. Epub 2014 Feb 12.
The delivery of urologic oncology care is susceptible to regional variation. In the current study, the authors sought to define patterns of care for patients undergoing genitourinary cancer surgery to identify underserved areas for urologic cancer care in Washington State.
The authors accessed the Washington State Comprehensive Hospital Abstract Reporting System from 2003 through 2007. They identified patients undergoing radical prostatectomy, radical cystectomy (RC), partial nephrectomy (PN), radical nephrectomy, and transurethral resection of the prostate (TURP). TURP was included for comparison as a reference procedure indicative of access to urologic care. Hospital service areas (HSAs) are where the majority of local patients are hospitalized; hospital referral regions (HRR) are where most patients receive tertiary care. The authors created multivariate hierarchical logistic regression models to examine patient and HSA characteristics associated with the receipt of urologic oncology care out of the HRR for each procedure.
Greater than one-half of patients went out of their HRR in 7 HSAs (11%) for radical prostatectomy, 3 HSAs (5%) for radical nephrectomy, 10 HSAs (15%) for PN, and 14 HSAs (22%) for RC. No HSAs had high export rates for TURP. Few patient factors were found to be associated with surgical care out of the HRR. High-export HSAs for PN and RC exhibited lower socioeconomic characteristics than low-export HSAs, adjusting for HSA population, race, and HSA procedure rates for PN and RC.
Patients living in areas with lower socioeconomic status have a greater need to travel for complex urologic surgery. Consideration of geographic delineation in the delivery of urologic oncology care may aid in regional quality improvement initiatives.
泌尿肿瘤学治疗的实施容易受到地域差异的影响。在目前的研究中，作者试图确定接受泌尿生殖系统癌症手术患者的治疗模式，以确定华盛顿州泌尿癌症治疗服务不足的地区。
作者从 2003 年至 2007 年访问了华盛顿州综合医院摘要报告系统。他们确定了接受根治性前列腺切除术、根治性膀胱切除术（RC）、部分肾切除术（PN）、根治性肾切除术和经尿道前列腺切除术（TURP）的患者。TURP 被包括在内作为参考程序，表明可以获得泌尿科护理。医院服务区（HSA）是大多数当地患者住院的地方；医院转诊区（HRR）是大多数患者接受三级护理的地方。作者创建了多变量分层逻辑回归模型，以检查与每个程序的 HRR 外接受泌尿肿瘤学治疗相关的患者和 HSA 特征。
在 7 个 HSA（11%）中，超过一半的患者因根治性前列腺切除术、3 个 HSA（5%）因根治性肾切除术、10 个 HSA（15%）因 PN 和 14 个 HSA（22%）因 RC 而离开 HRR。没有 HSA 因 TURP 而表现出高出口率。很少有患者因素与 HRR 外的手术护理相关。PN 和 RC 的高出口 HSA 比低出口 HSA 具有较低的社会经济特征，调整了 HSA 人口、种族以及 PN 和 RC 的 HSA 程序率。
生活在社会经济地位较低地区的患者更需要长途跋涉接受复杂的泌尿科手术。在提供泌尿肿瘤学治疗时考虑地理区域划分可能有助于区域质量改进计划。
