Chaudhary Muhammad Ali, Leow Jeffrey J, Mossanen Matthew, Chowdhury Ritam, Jiang Wei, Learn Peter A, Weissman Joel S, Chang Steven L
Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Harvard T H Chan School of Public Health, Boston, MA, USA.
Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
BMC Urol. 2017 Jul 11;17(1):56. doi: 10.1186/s12894-017-0247-x.
Patient preferences are assumed to impact healthcare resource utilization, especially treatment options. There is limited data exploring this phenomenon. We sought to identify factors associated with patients transferring care for prostatectomy, from military to civilian facilities, and the receipt of minimally invasive radical prostatectomy (MIRP).
Retrospective review of 2006-2010 TRICARE data identified men diagnosed with prostate cancer (ICD-9 185) receiving open radical prostatectomy (ORP; ICD-9: 60.5) or MIRP (ICD-9 60.5 + 54.21/17.42). Patients diagnosed at military facilities but underwent surgery at civilian facilities were defined as "transferring care". Logistic regression models identified predictors of transferring care for patients diagnosed at military facilities. A secondary analysis identified the predictors of MIRP receipt at civilian facilities.
Of 1420 patients, 247 (17.4%) transferred care. These patients were more likely to undergo MIRP (OR = 7.83, p < 0.01), and get diagnosed at low-volume military facilities (OR = 6.10, p < 0.01). Our secondary analysis demonstrated that transferring care was strongly associated with undergoing MIRP (OR = 1.51, p = 0.04).
Patient preferences induced a demand for greater utilization of MIRP and civilian facilities. Further work exploring factors driving these preferences and interventions tailoring them, based on evidence and cost considerations, is required.
患者偏好被认为会影响医疗资源的利用，尤其是治疗方案的选择。探索这一现象的数据有限。我们试图确定与患者将前列腺切除术护理从军事设施转移到民用设施以及接受微创根治性前列腺切除术（MIRP）相关的因素。
对2006 - 2010年国防医疗保健计划（TRICARE）数据进行回顾性分析，确定被诊断为前列腺癌（国际疾病分类第九版[ICD - 9]编码185）并接受开放性根治性前列腺切除术（ORP；ICD - 9编码：60.5）或MIRP（ICD - 9编码60.5 + 54.21/17.42）的男性患者。在军事设施被诊断但在民用设施接受手术的患者被定义为“转移护理”。逻辑回归模型确定了在军事设施被诊断患者转移护理的预测因素。二次分析确定了在民用设施接受MIRP的预测因素。
在1420名患者中，247名（17.4%）转移了护理。这些患者更有可能接受MIRP（比值比[OR] = 7.83，p < 0.01），并且在低容量军事设施被诊断（OR = 6.10，p < 0.01）。我们的二次分析表明，转移护理与接受MIRP密切相关（OR = 1.51，p = 0.04）。
患者偏好导致对更多地利用MIRP和民用设施的需求。需要进一步开展工作，探索驱动这些偏好的因素，并根据证据和成本考虑制定相应的干预措施。
