Pollock A M, Vickers N
Department of Public Health Sciences, St George's Hospital Medical School, London.
J Epidemiol Community Health. 1998 Jul;52(7):433-8. doi: 10.1136/jech.52.7.433.
This paper describes trends in hospital activity, hospital admissions, and treatments for colorectal cancer on residents of the South Thames regions (population 8 million) between 1989-1993 against the background of the Calman Report on the future of cancer services in England and Wales.
The analyses are derived from UK hospital data, which are collected as finished consultant episodes (FCEs). These are defined as episodes "where a patient has completed a period of care under a consultant and is either transferred to another consultant or is discharged." Probability matching was used to derive patient-based records, matching FCEs to admissions. A total of 18,542 South Thames residents aged 40-99 were admitted for colorectal cancer between 1 January 1989 and 31 December 1993. Time trends were analysed for procedures, FCEs, admissions, and patient numbers by admission type (ordinary admissions and day case admissions).
Between 1989 and 1993 inclusive colorectal cancer admissions doubled (98% increase p (trend) < 0.0001). These admissions were a result of a 6.4-fold increase in day case admissions and a 41% increase in ordinary admissions. The proportion of patients having a day case admission rose from 9% in 1989 to 18% in 1993 (p < 0.0001). Overall, 2894 (16%) patients had a day case admission; 1894 of these (65%) were also admitted as ordinary admissions. The number of FCEs and admissions per patient rose from 1.37 and 1.28 respectively in 1989 to 2.09 and 1.99 respectively in 1993. FCEs were between 5% and 8% higher than admissions over the five years. The number of ordinary (that is, overnight) inpatient admissions per patient rose from 1.23 to 1.41 over the five year period and day case inpatient admissions from 1.25 to 3.45. Chemotherapy accounted for 50% of the rise in day case admissions; colonoscopy and sigmoidoscopy were associated with a further 18%. Fourteen per cent of the increase in ordinary admissions was also because of chemotherapy.
The monitoring of site specific trends in admission, treatments, and procedures on a population basis should be a core requirement of health authorities to inform needs assessment, resource allocation, and service planning. The rise in admissions and chemotherapy treatments have implications for drug costs, laboratory and inpatient services, monitoring, and clinical audit.
本文描述了1989 - 1993年间，在《卡尔曼报告》关于英格兰和威尔士癌症服务未来的背景下，泰晤士河南部地区（人口800万）居民的医院活动、住院情况以及结直肠癌治疗的趋势。
分析数据源自英国医院数据，以完成的顾问诊疗事件（FCEs）形式收集。这些事件被定义为“患者在顾问医生的照料下完成一个疗程，然后转至另一位顾问医生处或出院”。采用概率匹配法得出基于患者的记录，将FCEs与住院情况进行匹配。1989年1月1日至1993年12月31日期间，共有18542名年龄在40 - 99岁的泰晤士河南部居民因结直肠癌住院。按入院类型（普通入院和日间病例入院）分析了手术、FCEs、住院情况及患者数量的时间趋势。
在1989年至1993年（含）期间，结直肠癌住院人数翻倍（增长98%，p（趋势）< 0.0001）。这些住院人数的增加是由于日间病例入院人数增长了6.4倍，普通入院人数增长了41%。日间病例入院患者的比例从1989年的9%升至1993年的18%（p < 0.0001）。总体而言，2894名（16%）患者接受了日间病例入院治疗；其中1894名（65%）也作为普通入院患者住院。每位患者的FCEs数量和住院次数分别从1989年的1.37次和1.28次升至1993年的2.09次和1.99次。在这五年中，FCEs比住院次数高出5%至8%。每位患者的普通（即过夜）住院次数在五年间从1.23次升至1.41次，日间病例住院次数从1.25次升至3.45次。化疗占日间病例入院人数增长的50%；结肠镜检查和乙状结肠镜检查又占18%。普通入院人数增加的14%也是由于化疗。
基于人群对特定部位的入院、治疗和手术趋势进行监测，应成为卫生当局进行需求评估、资源分配和服务规划的核心要求。住院人数和化疗治疗的增加对药品成本、实验室和住院服务、监测及临床审计都有影响。
