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Tzedakis S, Challine A, Katsahian S, Malka D, Jaquet R, Marchese U, Gaillard M, Coriat R, Dhote A, Mallet V, Jeddou H, Boudjema K, Fuks D, Lazzati A. Clinical care pathways of patients with biliary tract cancer: A French nationwide longitudinal cohort study. Eur J Cancer 2024; 202:114018. [PMID: 38502987 DOI: 10.1016/j.ejca.2024.114018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 03/07/2024] [Accepted: 03/12/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Although the incidence of BTC is raising, national healthcare strategies to improve care lack. We aimed to explore patient clinical care pathways and strategies to improve biliary tract cancer (BTC) care. METHODS We analysed the French National Healthcare database of all BTC inpatients between January 1, 2017 and December 31, 2021. Multinomial logistic regression adjusted odds ratios (aOR) were used to identify healthcare organisation factors that influenced access to curative care both overall and in a longitudinal sensibility analysis using optimal matching and hierarchical ascending classification to detect a subgroup of curative-care patients with a high survival over a two-year period. RESULTS A total of 19,825 new BTC patients and three clinical care pathways (CCP) were identified: 'Palliative care' (PC-CCP), 'Non-curative Care' (NCC-CCP) and 'Curative Care' (CC-CCP) involving 7669 (38.7%), 7721 (38.9%) and 4435 (22.4%) patients respectively. Out of 1200 centers involved in BTC treatment, 84%, 11% and 5% were of low- (<15 patients/year), medium- (15-30 patients/year) and high-volume (>30 patients/year) respectively. Among patient, tumor and hospital factors, BTC management in academic (aOR: 2.32; 95%CI: 1.98-2.71), private (2.51; 2.22-2.83), semi-private (2.25; 1.91-2.65) and in high- (2.09; 1.81-2.42) or medium-volume (1.49; 1.33-1.68) centers increased probability to CC-CCP. These results were maintained in a longitudinal cluster of 2363 (53%) CC-CCP patients presenting a higher two-year survival compared with the rest [96.4% (95.1; 97.6) vs. 38.8% (36.3; 41.4), log-rank p < 0.001]. CONCLUSIONS Among factors subject to healthcare policy improvement, the volume and type of centers managing BTC strongly influenced access to curative care.
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Affiliation(s)
- Stylianos Tzedakis
- INSERM, UMR 1138, Centre de Recherche des Cordeliers, Centre Inria de Paris, Équipe HeKA, France; AP-HP, Université Paris Cité, Groupe Hospitalier Cochin Port Royal, DMU Cancérologie et spécialités médico-chirurgicales, Service de chirurgie hépatobiliaire, digestive et endocrinienne, Paris, France.
| | - Alexandre Challine
- INSERM, UMR 1138, Centre de Recherche des Cordeliers, Centre Inria de Paris, Équipe HeKA, France; AP-HP, Sorbonne Université, Hôpital Saint Antoine, Service de chirurgie digestive, Paris, France
| | - Sandrine Katsahian
- INSERM, UMR 1138, Centre de Recherche des Cordeliers, Centre Inria de Paris, Équipe HeKA, France; AP-HP, Université Paris Cité, Hôpital Européen Georges-Pompidou, Service d'Épidémiologie et de Biostatistiques, Paris, France
| | - David Malka
- Institut Mutualiste Montsouris, Département d'Oncologie Médicale, Paris, France
| | - Romain Jaquet
- INSERM, UMR 1138, Centre de Recherche des Cordeliers, Centre Inria de Paris, Équipe HeKA, France; GH-Nord Essonne, Département de chirurgie digestive, Site Longjumeau, Longjumeau, France
| | - Ugo Marchese
- AP-HP, Université Paris Cité, Groupe Hospitalier Cochin Port Royal, DMU Cancérologie et spécialités médico-chirurgicales, Service de chirurgie hépatobiliaire, digestive et endocrinienne, Paris, France
| | - Martin Gaillard
- AP-HP, Université Paris Cité, Groupe Hospitalier Cochin Port Royal, DMU Cancérologie et spécialités médico-chirurgicales, Service de chirurgie hépatobiliaire, digestive et endocrinienne, Paris, France
| | - Romain Coriat
- AP-HP, Université Paris Cité, Groupe Hospitalier Cochin Port Royal, DMU Cancérologie et spécialités médico-chirurgicales, Service de gastroentérologie, d'endoscopie et d'oncologie digestive, Paris, France
| | - Alix Dhote
- AP-HP, Université Paris Cité, Groupe Hospitalier Cochin Port Royal, DMU Cancérologie et spécialités médico-chirurgicales, Service de chirurgie hépatobiliaire, digestive et endocrinienne, Paris, France
| | - Vincent Mallet
- AP-HP, Université Paris Cité, Groupe Hospitalier Cochin Port Royal, DMU Cancérologie et spécialités médico-chirurgicales, Service d'Hépatologie, Paris, France
| | - Heithem Jeddou
- Hôpital Pontchaillou, Service de chirurgie hépatobiliaire et digestive, Université Rennes 1, Rennes, France
| | - Karim Boudjema
- Hôpital Pontchaillou, Service de chirurgie hépatobiliaire et digestive, Université Rennes 1, Rennes, France
| | - David Fuks
- AP-HP, Université Paris Cité, Groupe Hospitalier Cochin Port Royal, DMU Cancérologie et spécialités médico-chirurgicales, Service de chirurgie hépatobiliaire, digestive et endocrinienne, Paris, France
| | - Andrea Lazzati
- AP-HP, Univeristé Sorbonne Paris Nord, Service de chirurgie digestive, bariatrique et endocrinienne, Hopital Avicenne, Bobigny, France
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Crawford EJ, Pincus D, Camp MW, Coyte PC. Cost savings of implementing the SickKids Paediatric Orthopaedic Pathway for proximal humerus fractures in Ontario, Canada. Paediatr Child Health 2018; 23:e109-e116. [PMID: 30455581 DOI: 10.1093/pch/pxx208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background The SickKids Paediatric Orthopaedic Pathway (SKPOP) for proximal humerus fractures may safely reduce the number of radiographs and follow-up assessments for children with these injuries. The study objective was to examine potential cost-savings of the SKPOP from the perspective of the Ministry of Health and Long-term Care (MOHLTC). Methods Two sets of resource profiles, based on direct health care costs were created for a cohort of patients treated at our institution: the first based on actual follow-up assessment values, and the other based on follow-up assessments according to the SKPOP. Differences between the two profiles represent potential cost-savings. A decision-analysis and associated probabilistic sensitivity analysis (PSA) were performed. Results In a cohort of 239 patients treated between 2009 and 2014, 92.9% (222) would have met SKPOP eligibility. Management according to this pathway would have reduced orthopaedic assessments and shoulder radiograph series by 83.6% (470/562) and 70.8% (367/589), respectively. For the cohort examined, a potential cost-savings of $30,040.56 ($135.32/patient) was observed. A PSA, accounting for variable SKPOP adherence and health care utilization, yielded cost-savings in 96.5% of the iterations run through the decision-analysis model and an average cost-savings of $57.82/patient. Based on these results and the annual provincial incidence rate of eligible patients (n=575), the MOHLTC could potentially save $33,249.45 annually with province-wide implementation. Conclusions Implementation of the SKPOP for a cohort of patients managed at our institution could have resulted in cost-savings due to substantial reductions in health care utilization. Cost-savings are likely to occur with provincial implementation of the SKPOP for proximal humerus fractures.
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Affiliation(s)
- Eric J Crawford
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario.,Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario
| | - Daniel Pincus
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario.,Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario
| | - Mark W Camp
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario.,Division of Orthopaedic Surgery, The Hospital for Sick Children, Toronto, Ontario
| | - Peter C Coyte
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario
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Vetter TR, Barman J, Boudreaux AM, Jones KA. Perceptions about the relative importance of patient care-related topics: a single institutional survey of its anesthesiologists, nurse anesthetists, and surgeons. BMC Anesthesiol 2016; 16:19. [PMID: 27004520 PMCID: PMC4804473 DOI: 10.1186/s12871-016-0187-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 03/18/2016] [Indexed: 11/13/2022] Open
Abstract
Background Persistently variable success has been experienced in locally translating even well-grounded national clinical practice guidelines, including in the perioperative setting. We have sought greater applicability and acceptance of clinical practice guidelines and protocols with our novel Perioperative Risk Optimization and Management Planning Tool (PROMPT™). This study was undertaken to survey our institutional perioperative clinicians regarding (a) their qualitative recommendations for (b) their quantitative perceptions of the relative importance of a series of clinical issues and patient medical conditions as potential topics for creating a PROMPT™. Methods We applied a mixed methods research design that involved collecting, analyzing, and “mixing” both qualitative and quantitative methods and data in a single study to answer a research question. Survey One was qualitative in nature and asked the study participants to list as free text up to 12 patient medical conditions or clinical issues that they perceived to be high priority topics for development of a PROMPT™. Survey Two was quantitative in nature and asked the study participants to rate each of these 57 specific, pre-selected clinical issues and patient medical conditions on an 11-point Likert scale of perceived importance as a potential topic for a PROMPT™. The two electronic, online surveys were completed by participants who were recruited from the faculty in our Department of Anesthesiology and Perioperative Medicine and Department of Surgery, and the cohort of hospital-employed certified registered nurse anesthetists. Results A total of 57 possible topics for a PROMPT™ was created and prioritized by our stakeholders. A strong correlation (r = 0.82, 95 % CI: 0.71, 0.89, P < 0.001) was observed between the quantitative clinician survey rating scores reported by the anesthesiologists/certified registered nurse anesthetists versus the surgeons. The quantitative survey displayed strong inter-rater reliability (ICC = 0.92, P < 0.001). Conclusions Our qualitative clinician stakeholder survey generated a comprehensive roster of clinical issues and patient medical conditions. Our subsequent quantitative clinician stakeholder survey indicated that there is generally strong agreement among anesthesiologists/certified registered nurse anesthetists and surgeons about the relative importance of these clinical issues and patient medical conditions as potential topics for perioperative optimization and risk management. Electronic supplementary material The online version of this article (doi:10.1186/s12871-016-0187-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Thomas R Vetter
- Department of Anesthesiology and Perioperative Medicine, University of Alabama School of Medicine, JT862, 619 19th Street South, Birmingham, AL, 35249-6810, USA.
| | - Joydip Barman
- Department of Anesthesiology and Perioperative Medicine, University of Alabama School of Medicine, JT862, 619 19th Street South, Birmingham, AL, 35249-6810, USA
| | - Arthur M Boudreaux
- Department of Anesthesiology and Perioperative Medicine, University of Alabama School of Medicine, JT862, 619 19th Street South, Birmingham, AL, 35249-6810, USA
| | - Keith A Jones
- Department of Anesthesiology and Perioperative Medicine, University of Alabama School of Medicine, JT862, 619 19th Street South, Birmingham, AL, 35249-6810, USA
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Abstract
Clinical care pathways are developed to standardize postoperative patient care and the main impetus is to improve quality of care, decrease variation in care and reduce costs. We report the clinical pathway of care adopted at our centre since the introduction of Uniportal VATS program for major lung resections.
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Affiliation(s)
- Majed Refai
- 1 Division of Thoracic Surgery, Ospedali Riuniti Ancona, Ancona, Italy ; 2 Section of Minimally Invasive Thoracic Surgery, Division of Thoracic Surgery, Ospedali Riuniti Ancona, Ancona, Italy ; 3 Anesthesia and Intensive Care Unit, Ospedali Riuniti Ancona, Ancona, Italy
| | - Michele Salati
- 1 Division of Thoracic Surgery, Ospedali Riuniti Ancona, Ancona, Italy ; 2 Section of Minimally Invasive Thoracic Surgery, Division of Thoracic Surgery, Ospedali Riuniti Ancona, Ancona, Italy ; 3 Anesthesia and Intensive Care Unit, Ospedali Riuniti Ancona, Ancona, Italy
| | - Michela Tiberi
- 1 Division of Thoracic Surgery, Ospedali Riuniti Ancona, Ancona, Italy ; 2 Section of Minimally Invasive Thoracic Surgery, Division of Thoracic Surgery, Ospedali Riuniti Ancona, Ancona, Italy ; 3 Anesthesia and Intensive Care Unit, Ospedali Riuniti Ancona, Ancona, Italy
| | - Armando Sabbatini
- 1 Division of Thoracic Surgery, Ospedali Riuniti Ancona, Ancona, Italy ; 2 Section of Minimally Invasive Thoracic Surgery, Division of Thoracic Surgery, Ospedali Riuniti Ancona, Ancona, Italy ; 3 Anesthesia and Intensive Care Unit, Ospedali Riuniti Ancona, Ancona, Italy
| | - Paolo Gentili
- 1 Division of Thoracic Surgery, Ospedali Riuniti Ancona, Ancona, Italy ; 2 Section of Minimally Invasive Thoracic Surgery, Division of Thoracic Surgery, Ospedali Riuniti Ancona, Ancona, Italy ; 3 Anesthesia and Intensive Care Unit, Ospedali Riuniti Ancona, Ancona, Italy
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