ABSTRACT
The centralization of complex surgical procedures for cancer in Catalonia may have led to geographical and socioeconomic inequities. In this population-based cohort study, we assessed the impacts of these two factors on 5-year survival and quality of care in patients undergoing surgery for rectal cancer (2011-12) and pancreatic cancer (2012-15) in public centers, adjusting for age, comorbidity, and tumor stage. We used data on the geographical distance between the patients' homes and their reference centers, clinical patient and treatment data, income category, and data from the patients' district hospitals. A composite 'textbook outcome' was created from five subindicators of hospitalization. We included 646 cases of pancreatic cancer (12 centers) and 1416 of rectal cancer (26 centers). Distance had no impact on survival for pancreatic cancer patients and was not related to worse survival in rectal cancer. Compared to patients with medium-high income, the risk of death was higher in low-income patients with pancreatic cancer (hazard ratio (HR) 1.46, 95% confidence interval (CI) 1.15-1.86) and very-low-income patients with rectal cancer (HR 5.14, 95% CI 3.51-7.52). Centralization was not associated with worse health outcomes in geographically dispersed patients, including for survival. However, income level remained a significant determinant of survival.
Subject(s)
Health Services Accessibility , Health Status Disparities , Pancreatic Neoplasms , Rectal Neoplasms , Cohort Studies , Humans , Pancreatic Neoplasms/surgery , Pancreatic Neoplasms/therapy , Rectal Neoplasms/surgery , Rectal Neoplasms/therapy , Social Class , Socioeconomic Factors , Spain/epidemiology , Pancreatic NeoplasmsABSTRACT
Uno de los retos más importantes de los sistemas sanitarios es decidir qué prestaciones se han de concentrar, ateniéndonos a su baja frecuencia, complejidad, riesgo, experiencia acumulada y costes, entre otros factores. La concentración ha de permitir garantizar la calidad de la prestación y los mejores resultados posibles. En este artículo se describen los elementos conceptuales, los criterios de referencia, el impacto en los centros y las condiciones necesarias que han de reunir los dispositivos, y que se han tenido en cuenta en la reordenación de la alta complejidad en Cataluña. También se exponen algunos de los temas que se han tratado en el proceso de reordenación, como la cardiología terciaria, tanto en el apartado de la cirugía cardíaca como en el de la angioplastia coronaria terapéutica, y la oncología, en el apartado de las cirugías oncológicas poco frecuentes. También se abordan el trasplante renal, la atención al politraumatismo grave y el despliegue de la tomografía por emisión de positrones
One of the principal challenges in healthcare systems is deciding which services have to be concentrated, taking into account, among other things, their low-frequency, complexity, risk, accumulated experience and costs., Concentration must make it possible to guarantee the quality of the service and the best results possible. This article describes, the conceptual elements, the benchmark criteria, the impact on the centres and the minimum conditions that the mechanisms must meet, which have been taken into account in the reorganisationof high-complexity services in Catalonia. Some of those issues that have been dealt with in the restructuring process are also considered, such as tertiary cardiology, in both the cardiac surgery and therapeuticcoronary angioplasty sections, and oncology in the section of infrequent oncological surgery. Renal transplants, serious multiple-trauma care and the use of positron emission tomography are also dealt with
Subject(s)
Humans , Medicine/organization & administration , Health Services/supply & distribution , Health Planning , Regional Health Planning , SpainABSTRACT
One of the principal challenges in healthcare systems is deciding which services have to be concentrated, taking into account, among other things, their low-frequency, complexity, risk, accumulated experience and costs., Concentration must make it possible to guarantee the quality of the service and the best results possible. This article describes, the conceptual elements, the benchmark criteria, the impact on the centres and the minimum conditions that the mechanisms must meet, which have been taken into account in the reorganisation of high-complexity services in Catalonia. Some of those issues that have been dealt with in the restructuring process are also considered, such as tertiary cardiology, in both the cardiac surgery and therapeutic coronary angioplasty sections, and oncology in the section of infrequent oncological surgery. Renal transplants, serious multiple-trauma care and the use of positron emission tomography are also dealt with.
