Variation in the use of intensity-modulated radiation therapy (IMRT) in the state of Michigan: 2005-2010.

219 Background: Interest is growing in value in health care, defined as better outcomes at lower costs. A primary driver of cost in radiation oncology is the use of IMRT. We examined the patterns and correlates of use of IMRT across Michigan using publicly available data. Methods: As a certificate of need state, Michigan requires every radiation oncology facility to report yearly the number of external beam and IMRT treatments delivered. Data for 2005-2008 were obtained through a Freedom of Information Act request of the Michigan Department of Community Health, while 2009-2010 data were available at its website. Percentage of external beam treatments delivered using IMRT (IMRT%) was examined across centers over time and repeated-measures longitudinal linear regression was used to identify factors associated with use. Results: During 2005-2010, 48 to 65 centers reported data. Median IMRT% (range) rose steadily during the study period: 2005 16% (0-64); 2006 21% (0-57); 2007 27% (0-79); 2008 37% (7-85); 2009 41% (0-87) 2010 45% (7-100). There was also significant between-center variation (see table). Regression modeling demonstrated that IMRT% was associated with year (+6.7% per year, p<0.0001), facility type (+7.1% freestanding versus hospital, p<0.11), facility annual volume (+5.0% high volume: 7,000+ versus low: <7,000, p=0.01) and the interaction between year and volume (low volume +2.4% per year versus high volume p<0.02). The significant interaction between year and volume suggests that the greatest IMRT% growth was in low volume centers (6.7% per year versus 4.3% per year for high volume). Conclusions: IMRT utilization has grown steadily across Michigan between 2005 and 2010. There is significant variation in its use that appears to be related in part to facility characteristics. The newly established Michigan Radiation Oncology Quality Collaborative (MROQC) is beginning to explore the use of IMRT in patients with breast and lung cancer statewide to identify those groups of patients where improved outcomes may justify its higher cost. [Table: see text]

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The Impact of Regionalization of Pancreaticoduodenectomy for Pancreatic Cancer in North Carolina since 2004

The American Surgeon ◽

10.1177/000313481408000619 ◽

2014 ◽

Vol 80 (6) ◽

pp. 561-566 ◽

Cited By ~ 12

Author(s):

Ryan Z. Swan ◽

David J. Niemeyer ◽

Ramanathan M. Seshadri ◽

Kyle J. Thompson ◽

Amanda Walters ◽

...

Keyword(s):

North Carolina ◽

Significant Risk ◽

High Volume ◽

Major Morbidity ◽

The North ◽

Time Period ◽

Improved Outcomes ◽

Before And After ◽

Low Volume ◽

The Impact

Pancreaticoduodenectomy (PD) carries a significant risk. High-volume centers (HVCs) provide improved outcomes and regionalization is advocated. Rapid regionalization could, however, have detrimental effects. North Carolina has multiple HVCs, including an additional HVC added in late 2006. We investigated regionalization of PD and its effects before, and after, the establishment of this fourth HVC. The North Carolina Hospital Discharge Database was queried for all PDs performed during 2004 to 2006 and 2007 to 2009. Hospitals were categorized by PD volume as: low (one to nine/year), medium (10 to 19/year), and high (20/year or more). Mortality and major morbidity was assessed by comparing volume groups across time periods. Number of PDs for cancer increased 91 per cent (129 to 246 cases) at HVCs, whereas decreasing at low-volume (62 to 58 cases) and medium-volume (80 to 46 cases) centers. Percentage of PD for cancer performed at HVCs increased significantly (47.6 to 70.3%) while decreasing for low- and medium-volume centers ( P < 0.001). Mortality was significantly less at HVCs (2.8%) compared with low-volume centers (10.3%) for 2007 to 2009. Odds ratio for mortality was significantly lower at HVCs during 2004 to 2006 (0.31) and 2007 to 2009 (0.34). Mortality for PD performed for cancer decreased from 6.6 to 4.6 per cent ( P = 0.31). Major morbidity was not significantly different between groups within either time period; however, there was a significant increase in major morbidity at low-volume centers ( P = 0.018). Regionalization of PD for cancer is occurring in North Carolina. Mortality was significantly lower at HVCs, and rapid regionalization has not detracted from the superior outcomes at HVCs.

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Outcome of Surgical Management of Pancreas Neoplasms in a Large Community Hospital

The American Surgeon ◽

10.1177/0003134820951490 ◽

2020 ◽

pp. 000313482095149

Author(s):

Sukanto Biswas ◽

Pascal Udekwu ◽

Anquonette Stiles ◽

Sara Roy

Keyword(s):

Blood Loss ◽

High Volume ◽

Therapy Outcomes ◽

Packed Red Blood Cells ◽

Process Outcomes ◽

Improved Outcomes ◽

Pancreatic Resections ◽

Pancreas Neoplasms ◽

Operative Performance ◽

Low Volume

Background Outcomes of complex pancreatic procedures have been used as an index for quality, and higher volume has been associated with improved outcomes, leading to advocacy for referral to those centers. The aim of the study was to evaluate the outcomes of pancreaticoduodenectomy (PD) at a low-volume referral center. Materials and Methods This retrospective study included patients who had a PD within a 7-year period. Operative performance parameters and outcomes were examined. Results Overall, there were 47 pancreatic resections, of which 38 met the inclusion criteria and were used for analyses. The overall median for blood loss, packed red blood cells units transfused, and postoperative days in hospital was as follows, respectively: 675 mL (interquartile range [IQR] = 500-900), 0 units (IQR = 0-2), 12 days (IQR = 9-18). Demographic characteristics, comorbidities, and complications align with the literature. The 30-day in-hospital mortality rate was 5%. Survival probability for those with pancreatic adenocarcinoma at 1 year was 52% and 7% for years 2 and 3. Discussion As cases increased, significant improvement was noted in process outcomes including blood loss, blood transfusion rates, and length of stay (LOS). Survival was comparable to that in the literature, with limitation of not being adjusted for adjuvant therapy. Outcomes of complex pancreatic procedures, like PD, at a low-volume center with commitment and adequate support systems, can match those at high-volume centers.

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High-Volume Hospitals with High-Volume and Low-Volume Surgeons: Is There a “Field Effect” for Pancreaticoduodenectomy?

The American Surgeon ◽

10.1177/000313481608200514 ◽

2016 ◽

Vol 82 (5) ◽

pp. 407-411 ◽

Cited By ~ 3

Author(s):

Thomas W. Wood ◽

Sharona B. Ross ◽

Ty A. Bowman ◽

Amanda Smart ◽

Carrie E. Ryan ◽

...

Keyword(s):

Hospital Mortality ◽

Field Effect ◽

Hospital Volume ◽

Patient Discharge ◽

High Volume ◽

Surgeon Volume ◽

Hospital Charges ◽

Leapfrog Group ◽

Discharge Status ◽

Low Volume

Since the Leapfrog Group established hospital volume criteria for pancreaticoduodenectomy (PD), the importance of surgeon volume versus hospital volume in obtaining superior outcomes has been debated. This study was undertaken to determine whether low-volume surgeons attain the same outcomes after PD as high-volume surgeons at high-volume hospitals. PDs undertaken from 2010 to 2012 were obtained from the Florida Agency for Health Care Administration. High-volume hospitals were identified. Surgeon volumes within were determined; postoperative length of stay (LOS), in-hospital mortality, discharge status, and hospital charges were examined relative to surgeon volume. Six high-volume hospitals were identified. Each hospital had at least one surgeon undertaking ≥ 12 PDs per year and at least one surgeon undertaking < 12 PDs per year. Within these six hospitals, there were 10 “high-volume” surgeons undertaking 714 PDs over the three-year period (average of 24 PDs per surgeon per year), and 33 “low-volume” surgeons undertaking 225 PDs over the three-year period (average of two PDs per surgeon per year). For all surgeons, the frequency with which surgeons undertook PD did not predict LOS, in-hospital mortality, discharge status, or hospital charges. At the six high-volume hospitals examined from 2010 to 2012, low-volume surgeons undertaking PD did not have different patient outcomes from their high-volume counterparts with respect to patient LOS, in-hospital mortality, patient discharge status, or hospital charges. Although the discussion of volume for complex operations has shifted toward surgeon volume, hospital volume must remain part of the discussion as there seems to be a hospital “field effect.”

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Mo1662 THE BOWEL CLEANSING NATIONAL INITIATIVE (BCLEAN): A HIGH-VOLUME SPLIT-DOSE POLYETHYLENE GLYCOL (PEG) PREPARATION VERSUS A LOW-VOLUME SPLIT-DOSE PEG SOLUTION WITH BISACODYL

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2019.03.852 ◽

2019 ◽

Vol 89 (6) ◽

pp. AB510-AB511

Author(s):

Alan N. Barkun ◽

Myriam Martel ◽

Ian L. Epstein ◽

Pierre Hallé ◽

Robert Hilsden ◽

...

Keyword(s):

Polyethylene Glycol ◽

High Volume ◽

Split Dose ◽

Bowel Cleansing ◽

National Initiative ◽

Low Volume

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Resilience to maintain quality of intrapartum care in war torn Yemen: a retrospective pre-post study evaluating effects of changing birth volumes in a congested frontline hospital

BMC Pregnancy and Childbirth ◽

10.1186/s12884-020-03507-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Josephine Obel ◽

Antonio Isidro Carrion Martin ◽

Abdul Wasay Mullahzada ◽

Ronald Kremer ◽

Nanna Maaløe

Keyword(s):

Quality Of Care ◽

Birth Outcomes ◽

Birth Outcome ◽

High Volume ◽

Maternal Health Service ◽

Service Access ◽

Intrapartum Care ◽

Health Service Access ◽

Low Volume

Abstract Background Fragile and conflict-affected states contribute with more than 60% of the global burden of maternal mortality. There is an alarming need for research exploring maternal health service access and quality and adaptive responses during armed conflict. Taiz Houbane Maternal and Child Health Hospital in Yemen was established during the war as such adaptive response. However, as number of births vastly exceeded the facility’s pre-dimensioned capacity, a policy was implemented to restrict admissions. We here assess the restriction’s effects on the quality of intrapartum care and birth outcomes. Methods A retrospective before and after study was conducted of all women giving birth in a high-volume month pre-restriction (August 2017; n = 1034) and a low-volume month post-restriction (November 2017; n = 436). Birth outcomes were assessed for all births (mode of birth, stillbirths, intra-facility neonatal deaths, and Apgar score < 7). Quality of intrapartum care was assessed by a criterion-based audit of all caesarean sections (n = 108 and n = 82) and of 250 randomly selected vaginal births in each month. Results Background characteristics of women were comparable between the months. Rates of labour inductions and caesarean sections increased significantly in the low-volume month (14% vs. 22% (relative risk (RR) 0.62, 95% confidence interval (CI) 0.45-0.87) and 11% vs. 19% (RR 0.55, 95% CI 0.42-0.71)). No other care or birth outcome indicators were significantly different. Structural and human resources remained constant throughout, despite differences in patient volume. Conclusions Assumptions regarding quality of care in periods of high demand may be misguiding - resilience to maintain quality of care was strong. We recommend health actors to closely monitor changes in quality of care when implementing resource changes; to enable safe care during birth for as many women as possible.

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Center-Level Procedure Volume Does Not Predict Failure-to-Rescue After Severe Complications of Oncologic Colon and Rectal Surgery

World Journal of Surgery ◽

10.1007/s00268-021-06296-w ◽

2021 ◽

Author(s):

Miriam Lillo-Felipe ◽

Rebecka Ahl Hulme ◽

Maximilian Peter Forssten ◽

Gary A. Bass ◽

Yang Cao ◽

...

Keyword(s):

Colorectal Cancer ◽

Postoperative Complications ◽

High Volume ◽

Cancer Surgery ◽

Colon And Rectal Surgery ◽

Surgical Volume ◽

Failure To Rescue ◽

Colorectal Cancer Surgery ◽

Procedure Volume ◽

Low Volume

Abstract Background The relationship between hospital surgical volume and outcome after colorectal cancer surgery has thoroughly been studied. However, few studies have assessed hospital surgical volume and failure-to-rescue (FTR) after colon and rectal cancer surgery. The aim of the current study is to evaluate FTR following colorectal cancer surgery between clinics based on procedure volume. Methods Patients undergoing colorectal cancer surgery in Sweden from January 2015 to January 2020 were recruited through the Swedish Colorectal Cancer Registry. The primary endpoint was FTR, defined as the proportion of patients with 30-day mortality after severe postoperative complications in colorectal cancer surgery. Severe postoperative complications were defined as Clavien–Dindo ≥ 3. FTR incidence rate ratios (IRR) were calculated comparing center volume stratified in low-volume (≤ 200 cases/year) and high-volume centers (> 200 cases/year), as well as with an alternative stratification comparing low-volume (< 50 cases/year), medium-volume (50–150 cases/year) and high-volume centers (> 150 cases/year). Results A total of 23,351 patients were included in this study, of whom 2964 suffered severe postoperative complication(s). Adjusted IRR showed no significant differences between high- and low-volume centers with an IRR of 0.97 (0.75–1.26, p = 0.844) in high-volume centers in the first stratification and an IRR of 2.06 (0.80–5.31, p = 0.134) for high-volume centers and 2.15 (0.83–5.56, p = 0.116) for medium-volume centers in the second stratification. Conclusion This nationwide retrospectively analyzed cohort study fails to demonstrate a significant association between hospital surgical volume and FTR after colorectal cancer surgery. Future studies should explore alternative characteristics and their correlation with FTR to identify possible interventions for the improvement of quality of care after colorectal cancer surgery.

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Colorectal cancer screening behaviors of general surgeons and first-degree family members: a survey-based study

BMC Gastroenterology ◽

10.1186/s12876-019-1106-x ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Suleyman Utku Celik ◽

Hasan Gorkem Cay ◽

Ersin Bayrakdar ◽

Aysima Ince ◽

Esra Nur Ince ◽

...

Keyword(s):

Colorectal Cancer ◽

Family Members ◽

High Volume ◽

Routine Screening ◽

Care Providers ◽

Crc Screening ◽

First Degree Relatives ◽

General Surgeons ◽

Low Volume ◽

Screening Behaviors

Abstract Background Colorectal cancer (CRC) screening rates are low in the general population and among health care providers. The aim of this study was to evaluate the CRC screening practices of general surgeons who provide specialized diagnostic testing and CRC treatment and to examine the CRC screening behaviors of their first-degree family members. Methods A cross-sectional survey was conducted among general surgeons who attended the 21st National Surgical Congress in Turkey held from April 11th to 15th, 2018. The survey included items on demographics, screening-related attitude, CRC screening options, barriers to CRC screening, and surgeons’ annual volumes of CRC cases. Results A total of 530 respondents completed the survey. Almost one-third of the responding surgeons (29.4%, n = 156) were aged over 50 years, among whom approximately half (47.1%, n = 74) reported having undergone CRC screening and preferring a colonoscopy as the screening modality (78.4%). Among general surgeons aged 50 years and older, high-volume surgeons (≥25 CRC cases per year) were more likely to undergo screening compared with low-volume surgeons (< 25 CRC cases per year). The respondents aged below 50 years reported that 56.1% (n = 210) of their first-degree relatives were up-to-date with CRC screening, mostly with colonoscopy. Compared to low-volume surgeons aged below 50 years, high-volume surgeons’ first-degree relatives were more likely to be up-to-date with CRC screening. Conclusion The survey results demonstrated that routine screening for CRC among surgeons and/or their first-degree relatives is currently not performed at the desired level. However, high-volume surgeons are more likely to participate in routine screening.

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Is high-intensity interval training a time-efficient exercise strategy to improve health and fitness?

Applied Physiology Nutrition and Metabolism ◽

10.1139/apnm-2013-0187 ◽

2014 ◽

Vol 39 (3) ◽

pp. 409-412 ◽

Cited By ~ 176

Author(s):

Jenna B. Gillen ◽

Martin J. Gibala

Keyword(s):

High Intensity ◽

Disease Risk ◽

Interval Training ◽

High Volume ◽

Oxidative Capacity ◽

High Intensity Interval Training ◽

Exercise Participation ◽

Cardiometabolic Disorders ◽

Low Volume ◽

High Intensity Interval

Growing research suggests that high-intensity interval training (HIIT) is a time-efficient exercise strategy to improve cardiorespiratory and metabolic health. “All out” HIIT models such as Wingate-type exercise are particularly effective, but this type of training may not be safe, tolerable or practical for many individuals. Recent studies, however, have revealed the potential for other models of HIIT, which may be more feasible but are still time-efficient, to stimulate adaptations similar to more demanding low-volume HIIT models and high-volume endurance-type training. As little as 3 HIIT sessions per week, involving ≤10 min of intense exercise within a time commitment of ≤30 min per session, including warm-up, recovery between intervals and cool down, has been shown to improve aerobic capacity, skeletal muscle oxidative capacity, exercise tolerance and markers of disease risk after only a few weeks in both healthy individuals and people with cardiometabolic disorders. Additional research is warranted, as studies conducted have been relatively short-term, with a limited number of measurements performed on small groups of subjects. However, given that “lack of time” remains one of the most commonly cited barriers to regular exercise participation, low-volume HIIT is a time-efficient exercise strategy that warrants consideration by health practitioners and fitness professionals.

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Relationship between hospital surgical volume, lobectomy rates, and adverse perioperative events at US epilepsy centers

Journal of Neurosurgery ◽

10.3171/2012.9.jns12776 ◽

2013 ◽

Vol 118 (1) ◽

pp. 169-174 ◽

Cited By ~ 37

Author(s):

Dario J. Englot ◽

David Ouyang ◽

Doris D. Wang ◽

John D. Rolston ◽

Paul A. Garcia ◽

...

Keyword(s):

Relative Risk ◽

Epilepsy Surgery ◽

Intractable Epilepsy ◽

High Volume ◽

Population Based ◽

Treatment Center ◽

Surgical Volume ◽

Related Factors ◽

Perioperative Morbidity ◽

Low Volume

Object Epilepsy surgery remains significantly underutilized. The authors recently reported that the number of lobectomies for localized intractable epilepsy in the US has not changed despite the implementation of clear evidence-based guidelines 10 years ago supporting early referral for surgery. To better understand why epilepsy surgery continues to be underused, the authors' objective was to carefully examine hospital-related factors related to the following: 1) where patients are being admitted for the evaluation of epilepsy, 2) rates of utilization for surgery across hospitals, and 3) perioperative morbidity between hospitals with low versus high volumes of epilepsy surgery. Methods The authors performed a population-based cohort study of US hospitals between 1990 and 2008 using the Nationwide Inpatient Sample (NIS), stratifying epilepsy surgery rates and trends as well as perioperative morbidity rates by hospital surgical volume. Results The number of lobectomies for epilepsy performed at high-volume centers (> 15 lobectomies/year) significantly decreased between 1990 and 2008 (F = 20.4, p < 0.001), while significantly more procedures were performed at middle-volume hospitals (5–15 lobectomies/year) over time (F = 16.1, p < 0.001). No time trend was observed for hospitals performing fewer than 5 procedures per year. However, patients admitted to high-volume centers were significantly more likely to receive lobectomy than those at low-volume hospitals (relative risk 1.05, 95% CI 1.03–1.08, p < 0.001). Also, the incidence of perioperative adverse events was significantly higher at low-volume hospitals (12.9%) than at high-volume centers (6.1%) (relative risk 1.08, 95% CI 1.03–1.07, p < 0.001). Conclusions Hospital volume is an important predictor of epilepsy surgery utilization and perioperative morbidity. Patients with medically refractory epilepsy should be referred to a comprehensive epilepsy treatment center for surgical evaluation by an experienced clinical team.

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