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Nguyen DD, Bouhadana D, Murad L, Stoddard M, Zheng X, Mao J, Zorn KC, Elterman DS, Bhojani N, Chughtai B. Effect of Surgeon and Facility Volume on Outcomes of Benign Prostatic Hyperplasia Surgery: Implications of Disparities in Access to Care at High-Volume Centers. Urology 2023; 172:97-104. [PMID: 36410527 DOI: 10.1016/j.urology.2022.09.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/01/2022] [Accepted: 09/15/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To report the effect of surgeon and facility volume on outcomes of transurethral resection of the prostate (TURP) and laser treatment of benign prostatic hyperplasia (BPH). We also investigate disparities in access to care by identifying demographic predictors of receipt of treatment at high-volume facilities. METHODS We used New York State Department of Health Statewide Planning and Research Cooperative System (SPARCS) data. We included 18,041 (41.4%) and 25,577 (58.6%) adult patients that underwent TURP and laser procedures in the outpatient setting between January 2005 and December 2018, respectively. Average annual surgeon and facility volumes were broken down by tertile. The effect of volume on short-term outcomes (30-day and 90-day readmission) was examined using mixed-effect logistic regression models. Cox-proportional-hazard models were used to assess the association between volume and long-term stricture development and reoperation. Demographic predictors of treatment at high-volume facilities were assessed using multinomial logistic regression. RESULTS High-volume facilities were more likely to offer laser procedures compared to low-volume facilities. Higher facility and surgeon volume were associated with lower odds of 30 and 90-day readmissions compared to low-volume facilities. There was no difference in reoperation and stricture development between surgeon volume groups. Medicaid insurance, Hispanic ethnicity, and Black race were inversely associated with treatment at high-volume facilities. CONCLUSION Higher surgeon and facility volumes were associated with lower odds of readmission. Higher facility volume was associated with lower hazards of reoperation and developing strictures. Medicaid insurance and non-white race were associated with lower odds of treatment at high-volume facilities, highlighting racial and socioeconomic disparities in access to high-volume BPH surgery facilities.
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Affiliation(s)
- David-Dan Nguyen
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - David Bouhadana
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Liam Murad
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Michelina Stoddard
- Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Xinyan Zheng
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY
| | - Jialin Mao
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY
| | - Kevin C Zorn
- Division of Urology, Department of Surgery, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
| | - Dean S Elterman
- Division of Urology, Department of Surgery, University Health Network (UHN), Toronto, Ontario, Canada
| | - Naeem Bhojani
- Division of Urology, Department of Surgery, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medical College/New York-Presbyterian, New York, NY.
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2
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Tan WS, Leow JJ, Marchese M, Sridhar A, Hellawell G, Mossanen M, Teoh JYC, Fowler S, Colquhoun AJ, Cresswell J, Catto JWF, Trinh QD, Kelly JD. Defining Factors Associated with High-quality Surgery Following Radical Cystectomy: Analysis of the British Association of Urological Surgeons Cystectomy Audit. EUR UROL SUPPL 2021; 33:1-10. [PMID: 34723215 PMCID: PMC8546928 DOI: 10.1016/j.euros.2021.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2021] [Indexed: 11/28/2022] Open
Abstract
Background Radical cystectomy (RC) is associated with high morbidity. Objective To evaluate healthcare and surgical factors associated with high-quality RC surgery. Design setting and participants Patients within the prospective British Association of Urological Surgeons (BAUS) registry between 2014 and 2017 were included in this study. Outcome measurements and statistical analysis High-quality surgery was defined using pathological (absence of positive surgical margins and a minimum of a level I lymph node dissection template with a minimum yield of ten or more lymph nodes), recovery (length of stay ≤10 d), and technical (intraoperative blood loss <500 ml for open and <300 ml for minimally invasive RC) variables. A multilevel hierarchical mixed-effect logistic regression model was utilised to determine the factors associated with the receipt of high-quality surgery and index admission mortality. Results and limitations A total of 4654 patients with a median age of 70.0 yr underwent RC by 152 surgeons at 78 UK hospitals. The median surgeon and hospital operating volumes were 23.0 and 47.0 cases, respectively. A total of 914 patients (19.6%) received high-quality surgery. The minimum annual surgeon volume and hospital volume of ≥20 RCs/surgeon/yr and ≥68 RCs/hospital/yr, respectively, were the thresholds determined to achieve better rates of high-quality RC. The mixed-effect logistic regression model found that recent surgery (odds ratio [OR]: 1.22, 95% confidence interval [CI]: 1.11-1.34, p < 0.001), laparoscopic/robotic RC (OR: 1.85, 95% CI: 1.45-2.37, p < 0.001), and higher annual surgeon operating volume (23.1-33.0 cases [OR: 1.54, 95% CI: 1.16-2.05, p = 0.003]; ≥33.1 cases [OR: 1.64, 95% CI: 1.18-2.29, p = 0.003]) were independently associated with high-quality surgery. High-quality surgery was an independent predictor of lower index admission mortality (OR: 0.38, 95% CI: 0.16-0.87, p = 0.021). Conclusions We report that annual surgeon operating volume and use of minimally invasive RC were predictors of high-quality surgery. Patients receiving high-quality surgery were independently associated with lower index admission mortality. Our results support the role of centralisation of complex oncology and implementation of a quality assurance programme to improve the delivery of care. Patient summary In this registry study of patients treated with surgical excision of the urinary bladder for bladder cancer, we report that patients treated by a surgeon with a higher annual operative volume and a minimally invasive approach were associated with the receipt of high-quality surgery. Patients treated with high-quality surgery were more likely to be discharged alive following surgery.
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Affiliation(s)
- Wei Shen Tan
- Division of Surgery & Interventional Science, University College London, London, UK.,Department of Urology, Royal Free London NHS Foundation Trust, London, UK
| | - Jeffrey J Leow
- Department of Urology, Tan Tock Seng Hospital, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Maya Marchese
- Center for Surgery and Public Health, Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ashwin Sridhar
- Division of Surgery & Interventional Science, University College London, London, UK.,Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Giles Hellawell
- Department of Urology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
| | - Matthew Mossanen
- Lank Center for Genitourinary Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Jeremy Y C Teoh
- The S H Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong
| | - Sarah Fowler
- British Association of Urological Surgeons, London, UK
| | - Alexandra J Colquhoun
- Department of Urology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Jo Cresswell
- Department of Urology, James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - James W F Catto
- Academic Urology Unit, University of Sheffield, Sheffield, UK
| | - Quoc-Dien Trinh
- Lank Center for Genitourinary Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, MA, USA
| | - John D Kelly
- Division of Surgery & Interventional Science, University College London, London, UK.,Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
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Reitblat C, Bain PA, Porter ME, Bernstein DN, Feeley TW, Graefen M, Iyer S, Resnick MJ, Stimson CJ, Trinh QD, Gershman B. Value-Based Healthcare in Urology: A Collaborative Review. Eur Urol 2021; 79:571-585. [PMID: 33413970 DOI: 10.1016/j.eururo.2020.12.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 12/02/2020] [Indexed: 11/15/2022]
Abstract
CONTEXT In response to growing concerns over rising costs and major variation in quality, improving value for patients has been proposed as a fundamentally new strategy for how healthcare should be delivered, measured, and remunerated. OBJECTIVE To systematically review the literature regarding the implementation and impact of value-based healthcare in urology. EVIDENCE ACQUISITION A systematic review was performed to identify studies that described the implementation of one or more elements of value-based healthcare in urologic settings and in which the associated change in healthcare value had been measured. Twenty-two publications were selected for inclusion. EVIDENCE SYNTHESIS Reorganization of urologic care around medical conditions was associated with increased use of guidelines-compliant care for men with prostate cancer, and improved outcomes for patients with lower urinary tract symptoms. Measuring outcomes for every patient was associated with improved prostate cancer outcomes, while the measurement of costs using time-driven activity-based costing was associated with reduced resource utilization in a pediatric multidisciplinary clinic. Centralization of urologic cancer care in the UK, Denmark, and Canada was associated with overall improved outcomes, although systems integration in the USA yielded mixed results among urologic cancer patients. No studies have yet examined bundled payments for episodes of care, expanding the geographic reach for centers of excellence, or building enabling information technology platforms. CONCLUSIONS Few studies have critically assessed the actual or simulated implementation of value-based healthcare in urology, but the available literature suggests promising early results. In order to effectively redesign care, there is a need for further research to both evaluate the potential results of proposed value-based healthcare interventions and measure their effects where already implemented. PATIENT SUMMARY While few studies have evaluated the implementation of value-based healthcare in urology, the available literature suggests promising early results.
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Affiliation(s)
- Chanan Reitblat
- Division of Urologic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Harvard Business School, Boston, MA, USA
| | - Paul A Bain
- Countway Library, Harvard Medical School, Boston, MA, USA
| | - Michael E Porter
- Harvard Business School, Boston, MA, USA; Institute for Strategy and Competitiveness, Harvard Business School, Boston, MA, USA
| | - David N Bernstein
- Institute for Strategy and Competitiveness, Harvard Business School, Boston, MA, USA; Harvard Combined Orthopedic Residency Program (HCORP), Massachusetts General Hospital, Boston, MA, USA
| | - Thomas W Feeley
- Harvard Business School, Boston, MA, USA; Institute for Strategy and Competitiveness, Harvard Business School, Boston, MA, USA
| | - Markus Graefen
- Martini-Klinik, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | | | - Matthew J Resnick
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA; Embold Health, Nashville, TN, USA
| | - C J Stimson
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Quoc-Dien Trinh
- Harvard Medical School, Boston, MA, USA; Division of Urology, Brigham and Women's Hospital, Boston, MA, USA
| | - Boris Gershman
- Division of Urologic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
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Brausi M, Hoskin P, Andritsch E, Banks I, Beishon M, Boyle H, Colecchia M, Delgado-Bolton R, Höckel M, Leonard K, Lövey J, Maroto P, Mastris K, Medeiros R, Naredi P, Oyen R, de Reijke T, Selby P, Saarto T, Valdagni R, Costa A, Poortmans P. ECCO Essential Requirements for Quality Cancer Care: Prostate cancer. Crit Rev Oncol Hematol 2020; 148:102861. [PMID: 32151466 DOI: 10.1016/j.critrevonc.2019.102861] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 12/23/2019] [Accepted: 12/23/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND ECCO Essential Requirements for Quality Cancer Care (ERQCC) are written by experts representing all disciplines involved in cancer care in Europe. They give oncology teams, patients, policymakers and managers an overview of essential care throughout the patient journey. PROSTATE CANCER Prostate cancer is the second most common male cancer and has a wide variation in outcomes in Europe. It has complex diagnosis and treatment challenges, and is a major healthcare burden. Care must only be a carried out in prostate/urology cancer units or centres that have a core multidisciplinary team (MDT) and an extended team of health professionals. Such units are far from universal in European countries. To meet European aspirations for comprehensive cancer control, healthcare organisations must consider the requirements in this paper, paying particular attention to multidisciplinarity and patient-centred pathways from diagnosis, to treatment, to survivorship.
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Affiliation(s)
- Maurizio Brausi
- European Association of Urology; Department of Urology, B. Ramazzini Hospital, Carpi-Modena, Italy
| | - Peter Hoskin
- European Society for Radiotherapy and Oncology (ESTRO); Mount Vernon Cancer Centre; University of Manchester, Manchester, United Kingdom
| | - Elisabeth Andritsch
- International Psycho-Oncology Society (IPOS); Clinical Department of Oncology, University Medical Centre of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Ian Banks
- European Cancer Organisation Patient Advisory Committee (ECCO PAC); European Men's Health Forum, Belgium
| | - Marc Beishon
- Cancer World, European School of Oncology (ESO), Milan, Italy.
| | - Helen Boyle
- International Society of Geriatric Oncology (SIOG); Department of Medical Oncology, Centre Léon-Bérard, Lyon, France
| | - Maurizio Colecchia
- European Society of Pathology (ESP); Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Roberto Delgado-Bolton
- European Association for Nuclear Medicine (EANM); Department of Diagnostic Imaging (Radiology) and Nuclear Medicine, San Pedro Hospital and Centre for Biomedical Research of La Rioja (CIBIR), University of La Rioja, Logroño, La Rioja, Spain
| | - Michael Höckel
- European Society of Oncology Pharmacy (ESOP); Kliniken Kassel, Gesundheit Nordhessen Holding, Kassel, Germany
| | - Kay Leonard
- European Oncology Nursing Society (EONS); Saint Luke's Radiation Oncology Centre, St James's Hospital, Dublin, Ireland
| | - József Lövey
- Organisation of European Cancer Institutes (OECI); National Institute of Oncology, Budapest, Hungary
| | - Pablo Maroto
- European Organisation for Research and Treatment of Cancer (EORTC); Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Ken Mastris
- European Cancer Organisation Patient Advisory Committee (ECCO PAC); Europa Uomo
| | - Rui Medeiros
- Association of European Cancer Leagues (ECL); Portuguese Cancer League, Instituto Portugues de Oncologia, Porto, Portugal
| | - Peter Naredi
- European Cancer Organisation (ECCO); Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Raymond Oyen
- European Society of Radiology (ESR); Department of Radiology, KU Leuven, Leuven, Belgium
| | - Theo de Reijke
- European Society of Surgical Oncology (ESSO); Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Peter Selby
- European Cancer Concord (ECC); Leeds Institute of Cancer and Pathology, University of Leeds; St James' University Hospital, Leeds, United Kingdom
| | - Tiina Saarto
- European Association for Palliative Care (EAPC); Palliative Care Center, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki, Finland
| | - Riccardo Valdagni
- European School of Oncology (ESO); Prostate Cancer Programme and Department of Radiation Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Sandhu J. ‘Robosurgeons vs. robosceptics’: can we afford robotic technology or can we afford not to? JOURNAL OF CLINICAL UROLOGY 2018. [DOI: 10.1177/2051415818812300] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aim: To investigate the clinical effectiveness and cost-effectiveness of robotic technology in robotic-assisted radical prostatectomy in comparison with laparoscopic radical prostatectomy and open radical prostatectomy. Methods: Cochrane, Medline and Embase databases were searched for randomised controlled trials to date on robotic-assisted radical prostatectomy versus laparoscopic radical prostatectomy and robotic-assisted radical prostatectomy versus open radical prostatectomy to assess clinical effectiveness. The British Association of Urology Surgeons database (2014–2016) and Cancer Research UK (2012–2014) were accessed in conjunction with media; keywords included: ‘Da Vinci’, ‘first robotic prostatectomy’, ‘hospital’ to estimate the cost-effectiveness of robotic-assisted radical prostatectomy in the National Health Service. Results: Functional outcome rates improved with robotic-assisted radical prostatectomy; this benefits the National Health Service financially although the clinical effectiveness may not meet the threshold of clinical importance. Regarding cost-effectiveness, approximately 12/43 (27.9%) centres achieved 150 robotic-assisted radical prostatectomies per year while 26/43 (60.4%) centres have managed to meet 100 robotic-assisted radical prostatectomies per year in 2014–2016. A national mean of 120–130 robotic-assisted radical prostatectomies per year for 2014–2016 was estimated. Conclusion: The cost of robotic-assisted radical prostatectomy is adequately justified if a high volume of surgeries (>150) are performed in high volume centres by high volume experienced surgeons per year. This can be achieved by subsidising the cost of robotic technology, centralisation and establishing robotic training centres.
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Jefferies ER, Cresswell J, McGrath JS, Miller C, Hounsome L, Fowler S, Rowe EW. Open radical cystectomy in England: the current standard of care - an analysis of the British Association of Urological Surgeons (BAUS) cystectomy audit and Hospital Episodes Statistics (HES) data. BJU Int 2018; 121:880-885. [PMID: 29359882 DOI: 10.1111/bju.14143] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | - Joanne Cresswell
- Department of Urology; James Cook University Hospital; Middlesbrough UK
| | - John S. McGrath
- Department of Urology; Royal Devon and Exeter Hospital; Exeter UK
| | - Catherine Miller
- Department of Urology; Royal Devon and Exeter Hospital; Exeter UK
| | - Luke Hounsome
- Public Health England Knowledge and Intelligence Team (South West); Bristol UK
| | - Sarah Fowler
- British Association of Urological Surgeons; Bristol UK
| | - Edward W. Rowe
- Bristol Urological Institute; Southmead Hospital; Bristol UK
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