Health Services Research and Regionalization of Care—From Policy to Practice: the Ontario Experience in Head and Neck Cancer

Abstract

Patients being treated at higher case volume hospitals or by higher case volume physicians appear to have better outcomes. This volume-outcome relationship is reviewed for oncologic and non-oncologic surgery with a focus on head and neck oncology. The impact of these research findings on health policy and health-care organization in Ontario, Canada, is then outlined. Lastly, future directions for quality improvement in surgical oncology are reviewed in the context of a universal health-care system. These include surgeon report cards, pre-operative checklists, linking funding and remuneration to the quality of delivered care, and the use of process improvement techniques.

Observed‐to‐expected ratio for adherence to treatment guidelines as a quality of care indicator for laryngeal cancer

“…[9][10][11] Regionalization of hospital care has been advocated based on a significant volume-outcome association, but arguments against regionalization cite unintended consequences of limiting access for populations dependent on smaller hospitals for care, and an adverse impact on the financial health of these hospitals and communities. 11,27,28 Our data support moving beyond structural measures such as volume alone as the main criterion for identifying high-performing centers. Ultimately, the inclusion of process measures emphasizes quality over quantity alone and will encourage all hospitals and physicians to provide NCCN guideline-compliant care.…”

“…This is an important observation, as hospital volume has been shown to be associated with improved outcomes for larynx cancer care, but the use of hospital volume as a proxy for quality is controversial . Regionalization of hospital care has been advocated based on a significant volume–outcome association, but arguments against regionalization cite unintended consequences of limiting access for populations dependent on smaller hospitals for care, and an adverse impact on the financial health of these hospitals and communities . Our data support moving beyond structural measures such as volume alone as the main criterion for identifying high‐performing centers.…”

Comparison of facility type outcomes for oral cavity cancer: Analysis of the national cancer database

“…If difficult cases require more complex surgery or specialized radiation and are considered outside the expertise of CCP and CCCP, they may require referral to AC. The model of regional head and neck centers relies on the concept that surgeons who experience a greater volume of cases are more likely to have an armamentarium of specialized surgical techniques and follow standard‐of‐care treatment algorithms, which should result in better outcomes …”

How many have you done, doctor? When is enough enough?

“…Without question, the volume of surgical cases performed by a surgeon correlates with better results. Numerous studies have shown that high‐volume surgeons have lower complication rates, shorter operative times, and better outcomes . Proving that for parotidectomy, however, has not been done and most likely will not be done.…”

“…Numerous studies have shown that high-volume surgeons have lower complication rates, shorter operative times, and better outcomes. [1][2][3][4] Proving that for parotidectomy, however, has not been done and most likely will not be done.…”