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Titolo:
DO SPECIALISTS DO IT BETTER - THE IMPACT OF SPECIALIZATION ON THE PROCESSES AND OUTCOMES OF CARE FOR CANCER-PATIENTS
Autore:
GRILLI R; MINOZZI S; TINAZZI A; LABIANCA R; SHELDON TA; LIBERATI A;
Indirizzi:
MARIO NEGRI INST PHARMACOL RES,UNIT CLIN POLICY ANAL,LAB CLIN EPIDEMIOL,VIA ERITREA 62 I-20157 MILAN ITALY MARIO NEGRI INST PHARMACOL RES,LAB CANC CLIN EPIDEMIOL I-20157 MILAN ITALY OSPED SAN CARLO BARROMEO MILANO,DEPT CLIN ONCOL MILAN ITALY UNIV YORK,NHS CTR REVIEW & DISSEMINAT YORK YO1 5DD N YORKSHIRE ENGLAND
Titolo Testata:
Annals of oncology
fascicolo: 4, volume: 9, anno: 1998,
pagine: 365 - 374
SICI:
0923-7534(1998)9:4<365:DSDIB->2.0.ZU;2-D
Fonte:
ISI
Lingua:
ENG
Soggetto:
BREAST-CONSERVING SURGERY; END RESULTS PROGRAM; OVARIAN-CANCER; CENTRALIZED TREATMENT; SURVIVAL RATES; QUALITY; TRIALS; HOSPITALS; CARCINOMA; PATTERNS;
Keywords:
CANCER CARE; OUTCOMES; SPECIALIZATION; SYSTEMATIC REVIEWS; QUALITY;
Tipo documento:
Review
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Citazioni:
61
Recensione:
Indirizzi per estratti:
Citazione:
R. Grilli et al., "DO SPECIALISTS DO IT BETTER - THE IMPACT OF SPECIALIZATION ON THE PROCESSES AND OUTCOMES OF CARE FOR CANCER-PATIENTS", Annals of oncology, 9(4), 1998, pp. 365-374

Abstract

Objective. To assess the impact of specialization on processes and outcomes of care for cancer patients. Data source: Papers published in English between 1980 and 1995 and identified through MEDLINE and Embase(MeSK terms: NEOPLASM (exploded), and PHYSICIAN PRACTICE PATTERNS (orDECISION MAKING, ATTITUDE OF HEALTH PERSONNEL, QUALITY OF HEALTH CARE, DELIVERY OF HEALTH CARE, HEALTH EDUCATION or OUTCOME ASSESSMENT HEALTH CARE), or through the reference lists of review articles. Study selection: Studies providing information on the association between quality of care indicators for cancer patients and clinician/centre degree of specialization. A total of 47 papers concerning 46 empirical studies were considered. Data extraction: For studies using process of care indicators, the proportion of specific procedures performed by specialists and non-specialists was abstracted. For studies using outcome indicators (e.g., mortality), the effect of specialization was quantifiedin terms of odds ratio (OR) expressing relative reduction in risk of death. The duality of individual studies using process or outcome indicators was assessed according to study design, avoidance of selection bias in patient identification and data analysis, degree of adjustmentof the comparison between clinicians/centres with different levels ofspecialization. Data synthesis: Specialized centres/clinicians fared better both when process and outcome indicators were used. While the former varied widely in different studies and their clinical relevance was often questionable, mortality was consistently lower when care wasprovided by specialized centres/clinicians, with the effect size being greater in smaller studies. For breast cancer, where all the studieswere of sufficiently good quality, a pooled estimate of the effect ofspecialization was performed which showed that specialized cancer carl was associated with an 18% (95% CI: 12%-23%) reduction in mortality. Conclusions: Despite the fact that care provided by specialized centres/clinicians appeared to be better both when assessed in relation to process indicators and to mortality this evidence should be consideredfar from conclusive because of major methodological flaws in these studies. Relative to current efforts to promote evidence-based policymaking, this review underscores the limited capability of scientific information to provide reliable guidelines for structuring better health care systems.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 04/04/20 alle ore 15:21:27