Trends in colorectal cancer care in southern England, 1989-1993: using HES data to inform cancer services reviews.

Trends in colorectal cancer care in southern England, 1989-1993: using HES data to inform cancer services reviews.

BACKGROUND: This paper describes trends in hospital activity, hospital admissions, and treatments for colorectal cancer on residents of the South Thames regions (population 8 million) between 1989-1993 against the background of the Calman Report on the future of cancer services in England and Wales. METHODS: The analyses are derived from UK hospital data, which are collected as finished consultant episodes (FCEs). These are defined as episodes "where a patient has completed a period of care under a consultant and is either transferred to another consultant or is discharged." Probability matching was used to derive patient-based records, matching FCEs to admissions. A total of 18,542 South Thames residents aged 40-99 were admitted for colorectal cancer between 1 January 1989 and 31 December 1993. Time trends were analysed for procedures, FCEs, admissions, and patient numbers by admission type (ordinary admissions and day case admissions). RESULTS: Between 1989 and 1993 inclusive colorectal cancer admissions doubled (98% increase p (trend) < 0.0001). These admissions were a result of a 6.4-fold increase in day case admissions and a 41% increase in ordinary admissions. The proportion of patients having a day case admission rose from 9% in 1989 to 18% in 1993 (p < 0.0001). Overall, 2894 (16%) patients had a day case admission; 1894 of these (65%) were also admitted as ordinary admissions. The number of FCEs and admissions per patient rose from 1.37 and 1.28 respectively in 1989 to 2.09 and 1.99 respectively in 1993. FCEs were between 5% and 8% higher than admissions over the five years. The number of ordinary (that is, overnight) inpatient admissions per patient rose from 1.23 to 1.41 over the five year period and day case inpatient admissions from 1.25 to 3.45. Chemotherapy accounted for 50% of the rise in day case admissions; colonoscopy and sigmoidoscopy were associated with a further 18%. Fourteen per cent of the increase in ordinary admissions was also because of chemotherapy. CONCLUSION: The monitoring of site specific trends in admission, treatments, and procedures on a population basis should be a core requirement of health authorities to inform needs assessment, resource allocation, and service planning. The rise in admissions and chemotherapy treatments have implications for drug costs, laboratory and inpatient services, monitoring, and clinical audit.

背景：本文描述了1989年至1993年间，在《卡尔曼关于英格兰和威尔士癌症服务未来的报告》的背景下，南泰晤士地区（人口800万）居民的医院活动、住院情况以及结直肠癌治疗的趋势。 方法：分析源自英国医院数据，这些数据是作为完成的会诊病例（FCEs）收集的。这些被定义为“患者在一名会诊医生的照料下完成一个疗程，然后要么转至另一名会诊医生处，要么出院”的病例。采用概率匹配来获取基于患者的记录，将FCEs与住院情况进行匹配。1989年1月1日至1993年12月31日期间，共有18542名40 - 99岁的南泰晤士地区居民因结直肠癌住院。按住院类型（普通住院和日间病例住院）对手术、FCEs、住院情况以及患者数量的时间趋势进行了分析。 结果：1989年至1993年（含）期间，结直肠癌住院人数增加了一倍（增长98%，p（趋势）<0.0001）。这些住院情况是日间病例住院增加6.4倍以及普通住院增加41%的结果。日间病例住院患者的比例从1989年的9%上升至1993年的18%（p <0.0001）。总体而言，2894名（16%）患者有日间病例住院；其中1894名（65%）也有普通住院。每位患者的FCEs数量和住院次数分别从1989年的1.37和1.28上升至1993年的2.09和1.99。在这五年期间，FCEs比住院次数高5% - 8%。每位患者的普通（即过夜）住院次数在五年期间从1.23上升至1.41，日间病例住院次数从1.25上升至3.45。化疗占日间病例住院增加的50%；结肠镜检查和乙状结肠镜检查又占18%。普通住院增加的14%也是因为化疗。 结论：基于人群对特定部位的住院、治疗和手术趋势进行监测应该是卫生部门的核心要求，以便为需求评估、资源分配和服务规划提供信息。住院人数和化疗治疗的增加对药品成本、实验室和住院服务、监测以及临床审计都有影响。