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Association between provider volume and healthcare expenditures of patients with oral cancer in Taiwan: a population-based study.

Chen LF, Ho HC, Su YC, Lee MS, Hung SK, Chou P, Lee CC, Lin LC, Lee CC - PLoS ONE (2013)

Bottom Line: The mean expenditure for oncological surgery was $11080±4645 (all costs are given in U.S. dollars) and $10129±9248 for one-year follow up.For one-year follow-up expenditure, patients in low-volume hospitals had an additional $3439 than those in high-volume hospitals; patient in low-volume surgeons and medium-volume surgeons incurred an additional expenditure of $2065 and $1811 than those in high-volume surgeons.Treatment strategies adapted by high-volume providers should be further analyzed.

View Article: PubMed Central - PubMed

Affiliation: Department of Emergency, National Yang-Ming University Hospital, I-Lan, Taiwan.

ABSTRACT

Background: Oral cancer requires considerable utilization of healthcare services. Wide resection of the tumor and reconstruction with free flap are widely used. Due to high recurrence rate, close follow-up is mandatory. This study was conducted to explore the relationship between the healthcare expenditure of oncological surgery and one-year follow up and provider volume.

Methods: From the National Health Insurance Research Database published by the Taiwanese National Health Research Institute, the authors selected a total of 1300 oral cancer patients who underwent tumor resection and free flap reconstruction in 2008. Hierarchical linear regression analysis was subsequently performed to explore the relationship between provider volume and expenditures of oncological surgery and one-year follow-up period. Emergency department (ED) visits and 30-day readmission rates were also analyzed.

Results: The mean expenditure for oncological surgery was $11080±4645 (all costs are given in U.S. dollars) and $10129±9248 for one-year follow up. For oncological surgery expenditure, oral cancer patients treated by low-volume surgeons had an additional $845 than those in high-volume surgeons in mixed model. For one-year follow-up expenditure, patients in low-volume hospitals had an additional $3439 than those in high-volume hospitals; patient in low-volume surgeons and medium-volume surgeons incurred an additional expenditure of $2065 and $1811 than those in high-volume surgeons. Oral cancer patients treated in low-volume hospitals incurred higher risk of 30-day readmission rate (odds ratio, 6.6; 95% confidence interval, 1.6-27).

Conclusions: After adjusting for physician, hospital, and patient characteristics, low-volume provider performing wide excision with reconstructive surgery in oral cancer patients incurred significantly higher expenditure for oncological surgery and one-year healthcare per patient than did others with higher volumes. Treatment strategies adapted by high-volume providers should be further analyzed.

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Related in: MedlinePlus

The difference of spending relative to the reference group (high-volume hospitals) in mixed models.
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pone-0065077-g004: The difference of spending relative to the reference group (high-volume hospitals) in mixed models.

Mentions: After adjusting for physician, hospital, and patient characteristics, the hierarchical linear regression revealed that the cost for oncological surgery per patient for low-volume surgeons was $845 higher than those of high-volume surgeons (P = 0.03), and $2065 higher than those of high-volume surgeons in healthcare expenditures for the 12-month follow-up period (P = 0.007) (Table 4 & Figure 3). Oral cancer patients treated in low-volume hospitals incurred higher one-year follow-up expenditure of $3439 than those in high-volume hospitals in mixed model (P = 0.004)(Table 4 & Figure 4).


Association between provider volume and healthcare expenditures of patients with oral cancer in Taiwan: a population-based study.

Chen LF, Ho HC, Su YC, Lee MS, Hung SK, Chou P, Lee CC, Lin LC, Lee CC - PLoS ONE (2013)

The difference of spending relative to the reference group (high-volume hospitals) in mixed models.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3672134&req=5

pone-0065077-g004: The difference of spending relative to the reference group (high-volume hospitals) in mixed models.
Mentions: After adjusting for physician, hospital, and patient characteristics, the hierarchical linear regression revealed that the cost for oncological surgery per patient for low-volume surgeons was $845 higher than those of high-volume surgeons (P = 0.03), and $2065 higher than those of high-volume surgeons in healthcare expenditures for the 12-month follow-up period (P = 0.007) (Table 4 & Figure 3). Oral cancer patients treated in low-volume hospitals incurred higher one-year follow-up expenditure of $3439 than those in high-volume hospitals in mixed model (P = 0.004)(Table 4 & Figure 4).

Bottom Line: The mean expenditure for oncological surgery was $11080±4645 (all costs are given in U.S. dollars) and $10129±9248 for one-year follow up.For one-year follow-up expenditure, patients in low-volume hospitals had an additional $3439 than those in high-volume hospitals; patient in low-volume surgeons and medium-volume surgeons incurred an additional expenditure of $2065 and $1811 than those in high-volume surgeons.Treatment strategies adapted by high-volume providers should be further analyzed.

View Article: PubMed Central - PubMed

Affiliation: Department of Emergency, National Yang-Ming University Hospital, I-Lan, Taiwan.

ABSTRACT

Background: Oral cancer requires considerable utilization of healthcare services. Wide resection of the tumor and reconstruction with free flap are widely used. Due to high recurrence rate, close follow-up is mandatory. This study was conducted to explore the relationship between the healthcare expenditure of oncological surgery and one-year follow up and provider volume.

Methods: From the National Health Insurance Research Database published by the Taiwanese National Health Research Institute, the authors selected a total of 1300 oral cancer patients who underwent tumor resection and free flap reconstruction in 2008. Hierarchical linear regression analysis was subsequently performed to explore the relationship between provider volume and expenditures of oncological surgery and one-year follow-up period. Emergency department (ED) visits and 30-day readmission rates were also analyzed.

Results: The mean expenditure for oncological surgery was $11080±4645 (all costs are given in U.S. dollars) and $10129±9248 for one-year follow up. For oncological surgery expenditure, oral cancer patients treated by low-volume surgeons had an additional $845 than those in high-volume surgeons in mixed model. For one-year follow-up expenditure, patients in low-volume hospitals had an additional $3439 than those in high-volume hospitals; patient in low-volume surgeons and medium-volume surgeons incurred an additional expenditure of $2065 and $1811 than those in high-volume surgeons. Oral cancer patients treated in low-volume hospitals incurred higher risk of 30-day readmission rate (odds ratio, 6.6; 95% confidence interval, 1.6-27).

Conclusions: After adjusting for physician, hospital, and patient characteristics, low-volume provider performing wide excision with reconstructive surgery in oral cancer patients incurred significantly higher expenditure for oncological surgery and one-year healthcare per patient than did others with higher volumes. Treatment strategies adapted by high-volume providers should be further analyzed.

Show MeSH
Related in: MedlinePlus