Thosani Darshak S, Meredith Luke T, West Richard, Till Brian M, Rahman Uzma, Mack Shale, Okusanya Olugbenga T, Evans Iii Nathaniel R, Grenda Tyler R
Department of Surgery, Sidney Kimmel Medical College, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania.
Ann Thorac Surg Short Rep. 2024 Mar 7;2(3):438-442. doi: 10.1016/j.atssr.2024.02.007. eCollection 2024 Sep.
As value-based care models continue to gain emphasis, along with the need for improved profiling across the continuum of lung cancer care, a better understanding of geographic variation in utilization of services surrounding episodes of care is needed.
In this retrospective cohort study of patients undergoing lung cancer resection from 2017 to 2019, we examined geographic variation in utilization of services surrounding episodes of lung cancer resection. We utilized hierarchical logistic regression models to determine risk-adjusted utilization of services. This study utilized inpatient and ambulatory databases across 4 states: New Jersey, Pennsylvania, Florida, and Maryland. All patients undergoing lung cancer resection were included. The primary outcome was risk-adjusted utilization of services.
Mean risk-adjusted utilization of ambulatory procedures across all hospital referral regions (HRRs) was 34.1% (95% CI 30.7%-37.6%), while the individual HRR utilization varied from 10.9% to 54.9% ( < .01). Mean risk-adjusted utilization of inpatient admissions in the 6 months prior to surgery was 15.3% (95% CI 13.9%-16.7%), ranging from 7.4% to 24.7% ( = .07) across HRRs. Finally, mean risk-adjusted utilization of inpatient hospitalizations in the 6 months following surgery was 19.4% (95% CI 17.7-21.0%), ranging from 10.0% to 33.6% ( = .19) across HRRs.
Overall, we observed that utilization of ambulatory services varied significantly across HRRs, while inpatient utilization did not demonstrate significant variation. Given these findings, there may be geographic drivers of variation in the utilization of services surrounding lung cancer resection.
随着基于价值的医疗模式持续受到重视，以及在肺癌全程护理中改善病例分析的需求不断增加，有必要更好地了解围绕护理期间服务利用情况的地理差异。
在这项对2017年至2019年接受肺癌切除术患者的回顾性队列研究中，我们考察了肺癌切除期间服务利用情况的地理差异。我们使用分层逻辑回归模型来确定经风险调整后的服务利用率。本研究利用了新泽西州、宾夕法尼亚州、佛罗里达州和马里兰州4个州的住院和门诊数据库。纳入所有接受肺癌切除术的患者。主要结局是经风险调整后的服务利用率。
所有医院转诊区域（HRR）的门诊手术平均经风险调整利用率为34.1%（95%置信区间30.7%-37.6%），而各HRR的利用率从10.9%到54.9%不等（P<0.01）。术前6个月住院入院的平均经风险调整利用率为15.3%（95%置信区间13.9%-16.7%），各HRR的范围为7.4%至24.7%（P=0.07）。最后，术后6个月住院治疗的平均经风险调整利用率为19.4%（95%置信区间17.7%-21.0%），各HRR的范围为10.0%至33.6%（P=0.19）。
总体而言，我们观察到各HRR的门诊服务利用率差异显著，而住院服务利用率未显示出显著差异。鉴于这些发现，肺癌切除期间服务利用情况的差异可能存在地理驱动因素。
