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[article] Effect of hospital volume on processes of care and 5-year survival after breast cancer : A population-based study on 25 000 women [printed text] / France Vrijens , Author ; Sabine Stordeur, Author ; Koen Beirens, Author ; Stephan Devriese , Author ; E. Van Eycken, Author ; Joan Vlayen , Author . - 2012 . - 261-266.
Languages : English (eng)
in The Breast > 21(2012)03 [06/01/2012] . - 261-266

Descriptors:	Classification W 1 Serials. Periodicals Indexation 2008-52 ; Adult ; Aged, 80 and over ; Belgium ; Breast Neoplasms ; Hospital Mortality ; Outcome Assessment (Health Care) ; Quality Indicators, Health Care ; R150 ; statistics and numerical data [Subheading]
Abstract:	PURPOSE: To compare processes of care and survival for breast cancer by hospital volume in Belgium, based on 11 validated process quality indicators. METHODS: Three databases were linked at the patient level: the Cancer Registry, the population and the claims databases. All women with a diagnosis of invasive breast cancer between 2004 and 2006 were selected. Hospitals were classified according to their annual volume of treated patients: <50 (very low), 50-99 (low), 100-149 (medium) and >/= 150 patients (high). Cox and logistic regression models were used to test differences in 5-year survival and in achievement of process indicators across volume categories, adjusting for age, tumor grade and stage. RESULTS: A total of 25178 women with invasive breast cancer were treated in 111 hospitals. Half of the hospitals (N=57) treated <50 patients per year. Six of eleven process indicators showed higher rates in high-volume hospitals: multidisciplinary team meeting, cytological and/or histological assessment before surgery, use of neoadjuvant chemotherapy, breast-conserving surgery rate, adjuvant radiotherapy after breast-conserving surgery, and follow-up mammography. Higher volume was also associated with improved survival. The 5-year observed survival rates were 74.9%, 78.8%, 79.8% and 83.9% for patients treated in very-low-, low-, medium- and high-volume hospitals respectively. After case-mix adjustment, patients treated in very-low- or low-volume hospitals had a hazard ratio for death of 1.26 (95% CI 1.12, 1.42) and 1.15 (95% CI 1.01, 1.30) respectively compared with high-volume hospitals. CONCLUSION: Survival benefits reported in high-volume hospitals suggest a better application of recommended processes of care, justifying the centralization of breast cancer care in such hospitals.
Link for e-copy:	http://dx.doi.org/10.1016/j.breast.2011.12.002
Format of e-copy:	PDF [Requires Subscription]
Record link:	https://kce.docressources.info/index.php?lvl=notice_display&id=3734

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