A Risk-Adjusted Model for Ovarian Cancer Care and Disparities in Access to High-Performing Hospitals.切换为中文
OBJECTIVE:To validate the observed/expected ratio for adherence to ovarian cancer treatment guidelines as a risk-adjusted measure of hospital quality care, and to identify patient characteristics associated with disparities in access to high-performing hospitals. METHODS:This was a retrospective population-based study of stage I-IV invasive epithelial ovarian cancer reported to the California Cancer Registry between 1996 and 2014. A fit logistic regression model, which was risk-adjusted for patient and disease characteristics, was used to calculate the observed/expected ratio for each hospital, stratified by hospital annual case volume. A Cox proportional hazards model was used for survival analyses, and a multivariable logistic regression model was used to identify independent predictors of access to high-performing hospitals. RESULTS:The study population included 30,051 patients who were treated at 426 hospitals: low observed/expected ratio (n=304) 23.5% of cases; intermediate observed/expected ratio (n=92) 57.8% of cases; and high observed/expected ratio (n=30) 18.7% of cases. Hospitals with high observed/expected ratios were significantly more likely to deliver guideline-adherent care (53.3%), compared with hospitals with intermediate (37.8%) and low (27.5%) observed/expected ratios (P<.001). Median disease-specific survival time ranged from 73.0 months for hospitals with high observed/expected ratios to 48.1 months for hospitals with low observed/expected ratios (P<.001). Treatment at a hospital with a high observed/expected ratio was an independent predictor of superior survival compared with hospitals with intermediate (hazard ratio [HR] 1.06, 95% CI 1.01-1.11, P<.05) and low (HR 1.10, 95% CI 1.04-1.16, P<.001) observed/expected ratios. Being of Hispanic ethnicity (odds ratio [OR] 0.85, 95% CI 0.78-0.93, P<.001, compared with white), having Medicare insurance (OR 0.74, 95% CI 0.68-0.81 P<.001, compared with managed care), having a Charlson Comorbidity Index score of 2 or greater (OR 0.91, 95% CI 0.83-0.99, P<.05), and being of lower socioeconomic status (lowest quintile OR 0.41, 95% CI 0.36-0.46, P<.001, compared with highest quintile) were independent negative predictors of access to a hospital with a high observed/expected ratio. CONCLUSION:Ovarian cancer care at a hospital with a high observed/expected ratio is an independent predictor of improved survival. Barriers to high-performing hospitals disproportionately affect patients according to sociodemographic characteristics. Triage of patients with suspected ovarian cancer according to a performance-based observed/expected ratio hospital classification is a potential mechanism for expanded access to expert care.
OBSTETRICS AND GYNECOLOGY
OBSTETRICS AND GYNECOLOGY 期刊简介
Popularly known as "The Green Journal", Obstetrics & Gynecology publishes original articles and research studies on: scientific advances new medical and surgical techniques obstetric management clinical evaluation of drugs and instruments. In addition to its authoritative articles and studies, Obstetrics & Gynecology continues to feature the sections that obstetricians and gynecologists around the world have come to depend upon - After Office Hours, Case Reports, Instruments and Methods, Graduate Education, Editorials, and Letters.Obstetrics & Gynecology''s rigorous editorial policies ensure that all articles are of the highest quality and that they are published while current. These policies have made The Green Journal one of the most respected and most consulted journals in the world.Obstetrics & Gynecology is the most complete and reliable source of information on current developments in women''s health care.
OBSTETRICS AND GYNECOLOGY 期刊中科院评价数据
OBSTETRICS & GYNECOLOGY(产科医学和妇科医学) 2区
OBSTETRICS AND GYNECOLOGY 期刊CiteScore评价数据
大类(学科)：Medicine 小类(学科)：Obstetrics and Gynecology
OBSTETRICS AND GYNECOLOGY 期刊常见问题
OBSTETRICS AND GYNECOLOGY 投稿经验
研究方向：临床 肿瘤 回顾性分析
接受率： 非常困难（几乎不命中）s投稿一个月了，还是没到under review，也不知道啥意思？2019-02-18
研究方向：OBSTETRICS & GYNECOLOGY-
研究方向：OBSTETRICS & GYNECOLOGY-