Netherlands Comprehensive Cancer Organisation, dept. of research, Utrecht, the Netherlands.
University of Twente, School for Management and Governance, dept. of Health Technology and Services Research, Enschede, The Netherlands.
PLoS One. 2018 Apr 12;13(4):e0195673. doi: 10.1371/journal.pone.0195673. eCollection 2018.
To improve quality of care, centralisation of cancer services in high-volume centres has been stimulated. Studies linking specialisation and high (surgical) volumes to better outcomes already appeared in the 1990's. However, actual centralisation was a difficult process in many countries. In this study, factors influencing the centralisation of cancer services in the Netherlands were determined.
Centralisation patterns were studied for three types of cancer that are known to benefit from high surgical caseloads: oesophagus-, pancreas- and bladder cancer. The Netherlands Cancer Registry provided data on tumour and treatment characteristics from 2000-2013 for respectively 8037, 4747 and 6362 patients receiving surgery. By plotting timelines of centralisation of cancer surgery, relations with the appearance of (inter)national scientific evidence, actions of medical specialist societies, specific regulation and other important factors on the degree of centralisation were ascertained.
For oesophagus and pancreas cancer, a gradual increase in centralisation of surgery is seen from 2005 and 2006 onwards following (inter)national scientific evidence. Centralisation steps for bladder cancer surgery can be seen in 2010 and 2013 anticipating on the publication of norms by the professional society. The most influential stimulus seems to have been regulations on minimum volumes.
Scientific evidence on the relationship between volume and outcome lead to the start of centralisation of surgical cancer care in the Netherlands. Once a body of evidence has been established on organisational change that influences professional practice, in addition some form of regulation is needed to ensure widespread implementation.
为了提高医疗质量，癌症服务的集中化已经在高容量中心得到了推动。早在 20 世纪 90 年代，就有研究将专业化和高（手术）量与更好的结果联系起来。然而，在许多国家，实际的集中化是一个困难的过程。在这项研究中，确定了影响荷兰癌症服务集中化的因素。
研究了三种已知受益于高手术量的癌症的集中化模式：食管癌、胰腺癌和膀胱癌。荷兰癌症登记处提供了 2000-2013 年分别接受手术的 8037、4747 和 6362 名患者的肿瘤和治疗特征数据。通过绘制癌症手术集中化的时间线，确定了与（国际）科学证据的出现、医学专家协会的行动、特定法规和其他对集中化程度有重要影响的因素之间的关系。
自（国际）科学证据出现以来，食管癌和胰腺癌的手术集中化程度从 2005 年和 2006 年开始逐渐增加。膀胱癌手术集中化步骤可以在 2010 年和 2013 年看到，这是对专业协会发布规范的预期。最具影响力的刺激因素似乎是关于最低量的规定。
关于量与结果之间关系的科学证据导致了荷兰外科癌症护理集中化的开始。一旦建立了关于影响专业实践的组织变革的证据基础，除了一些形式的监管外，还需要确保广泛实施。
