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Date: May 18, 2007 (Friday)
Time: 12:30 – 14:00 (sandwich lunch from 12:30 –12:45; seminar begins at 12:45)
Venue: Mrs Chen Yang Foo Oi Telemedicine Centre, 2/F, William MW Mong Block, Faculty of Medicine Building, 21 Sassoon Road, Pokfulam, Hong Kong
Abstract:
Objective: |
To assess associations of patient characteristics with quality-related characteristics of the hospitals where they were treated for colorectal cancer and the role of these associations in disparities in treatment quality affecting vulnerable patient groups or variations across health plans. |
Setting: |
Population-based cancer registry in California. |
Participants: |
A total of 38 237 patients diagnosed with stage I–III (non-metastatic) colorectal cancer in California between 1994 and 1998. |
Methods: |
Registry data were linked with hospital discharge abstracts, US census data, and Medicare enrollment data. The associations of patients’ sociodemographic, clinical, and geographic covariates with treatment at high-volume institutions were assessed with logistic regression. The associations of patients’ covariates with the risk-adjusted 30-day mortality rates of the hospitals where they received surgery were tested with linear regression. |
Results: |
Patients with more advanced tumor stage or more extensive comorbidity, those of Hispanic or Asian race/ethnicity, and those from less affluent communities were less likely to undergo surgery at high-volume institutions and were treated at hospitals with higher risk-adjusted 30-day postoperative mortality rates than those who were less severely ill, white, or more affluent, respectively (all P < 0.05). Black patients also received surgery at hospitals with above-average mortality. Among patients 65 years and older, Medicare managed-care enrollees underwent surgery in higher-volume hospitals than Medicare fee-for-service enrollees, and there was substantial variation in hospital volume and adjusted hospital mortality among Medicare managed-care plans.
Conclusion: Improving access of sicker, poorer, and minority patients to high-quality hospitals for cancer surgery may improve their outcomes. Further study of processes affecting hospital referral is warranted. |
Keywords: |
case-mix adjustment, colorectal neoplasms, colorectal surgery, delivery of health care, hospitals, outcome and process assessment, quality of health care |
Bio-sketch:
Dr Zhang joined the faculty of Peking University Guanghua School of Management in September 2004, with a joint appointment from School of Government at Peking University. He received his Ph.D. in Health Policy from Harvard University in 2004 (an interfaculty program between Graduate School of Arts and Sciences, Kennedy School of Government, Business School, Medical School and School of Public Health), and M.D. from Peking Union Medical College in 1998 after completing pre-med study at Peking University.
Prior to joining Peking University, he had teaching experiences at Kennedy School of Government at Harvard, and had served as a Resident Tutor at Eliot House, Harvard College for 5 years. Having completed his Ph.D. dissertation on quality of cancer care at Harvard Medical School, Dr. Zhang has additional research interests in consumer assessment of health care, physician behavior, provider profiling, decision sciences in health care, and medical error/patient safety.
He is the recipient of AT&T Leadership Award and Sloan Dissertation Fellowship on Managed Care. He is currently leading a project on "Informal Payments in China’s Health Care Sector", in collaboration with the Wharton School.
Registration:
For registration and enquiries, please call Ms Maggie Cheuk at 2819-2841 or email mhrn@hkusua.hku.hk
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