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    Impact of patient choice and hospital competition on patient outcomes after prostate cancer surgery: a national population-based study.

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    Authors
    Aggarwal, A
    Sujenthiran, A
    Lewis, D
    Walker, K
    Cathcart, P
    Clarke, Noel W
    Sullivan, R
    van der Meulen, J
    Affiliation
    Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
    Issue Date
    2019
    
    Metadata
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    Abstract
    BACKGROUND: Policies that encourage patient choice and hospital competition have been introduced across several countries with the purpose of improving the quality of health care services. The objective of the current national cohort study was to analyze the correlation between choice and competition on outcomes after cancer surgery using prostate cancer as a case study. METHODS: The analyses included all men who underwent prostate cancer surgery in the United Kingdom between 2008 and 2011 (n = 12,925). Multilevel logistic regression was used to assess the effect of a radical prostatectomy center being located in a competitive environment (based on the number of centers within a threshold distance) and being a successful competitor (based on the ability to attract patients from other hospitals) on 3 patient-level outcomes: postoperative length of hospital stay >3 days, 30-day emergency readmissions, and 2-year urinary complications. RESULTS: With adjustment for patient characteristics, men who underwent surgery in centers located in a stronger competitive environment were less likely to have a 30-day emergency readmission, irrespective of the type or volume of procedures performed at each center (odds ratio, 0.46; 95% confidence interval, 0.36-0.60; P = .005). Men who received treatment at centers that were successful competitors were less likely to have a length of hospital stay >3 days (odds ratio, 0.49; 95% confidence interval, 0.25-0.94; P = .02). CONCLUSIONS: The current results suggest for the first time that hospital competition improves short-term outcomes after prostate cancer surgery. Further evaluation of the potential role of patient choice and hospital competition is required to inform health service design in contrast to the role of top-down-driven approaches, which have focused on centralization of services.
    Citation
    Aggarwal AK, Sujenthiran A, Lewis D, Walker K, Cathcart P, Clarke NW, et al. Impact of patient choice and hospital competition on patient outcomes after prostate cancer surgery: a national population-based study. Cancer. 2019 Feb 1.
    Journal
    Cancer
    URI
    http://hdl.handle.net/10541/621555
    DOI
    10.1002/cncr.31987
    PubMed ID
    30707779
    Additional Links
    https://dx.doi.org/10.1002/cncr.31987
    Type
    Article
    Language
    en
    ae974a485f413a2113503eed53cd6c53
    10.1002/cncr.31987
    Scopus Count
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