Saving Lives by Routing Patients

from the American Association for Thoracic Surgery annual meeting in Toronto 

Score one for the health policy wonks, whose efforts to regionalize cancer care in Ontario starting in 2004 produced a significant survival benefit in patients undergoing partial lung resection. 

image courtesy Public Health Image Library, CDC

In 2004, Ontario Cancer Care set up a regionalized hospital system that began to funnel certain patients to a select group of high-volume centers to better insure that they received their surgery from the most experienced teams. At the AATS meeting last week, Toronto thoracic surgeon Christian Finley reported findings from his analysis of the more than 19,000 lung lobectomies done in Ontario during 1999-2007. 

He found that in 1999, 2,120 patients had lung resection surgery at 77 Ontario hospitals. By 2007, more than 2,500 patients underwent a lobectomy, but at only 69 hospitals. During the 9 years studied, the percent of hospitals that did more than 60 lobectomies a year rose from 50% in 1999 to 65% in 2007. 

Concurrently, in-hospital mortality fell from more than 3% in 1999 to less than 2% in 2007, a relative drop of 45%. The sharpest inflection came as the regionalized program launched in 2004, with the absolute mortality rate dropping by 1% between 2003 and 2005. 

With more than 2,000 patients having lobectomy surgery each year, that translates into more than 20 lives saved annually just because some health-care bureaucrats began shunting patients away from the dabbler hospitals–in some cases hospitals did fewer than 10 of these cases a year–and toward experienced centers. 

One more noteworthy finding: It wasn’t lobectomy volume itself that seemed critical. Hospitals that boosted their patient load from, say, 60 cases a year to 110 cases, didn’t necessarily improve. Dr. Finley therefore concluded that higher volume marked experienced hospitals, the ones with comprehensive intensive care units and seasoned nurses who could quickly identify postoperative patients in trouble and knew how to help them. 

—Mitchel Zoler (on Twitter @mitchelzoler)

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Filed under Health Policy, Hospital and Critical Care Medicine, IMNG, Internal Medicine, Oncology, Surgery, Thoracic Surgery

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