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Variation in Use of Breast-Conserving Surgery in Lombardia, Italy

Published online by Cambridge University Press:  10 March 2009

Roberto Grilli  and
Francesca Repetto
Roberto Grilli
Affiliation:
Mario Negri Institute
Francesca Repetto
Affiliation:
Regional Health Authority, Lombardia
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Abstract

The extent of variation in the use of breast-conserving surgery was analyzed using the 1990 and 1991 hospital discharge data of Lombardia, Italy. The proportion of patients undergoing breast-conserving surgery for unilateral breast cancer was estimated for each of the 10 geographic areas (9 provinces plus metropolitan Milano) in which the region is divided. Overall, the rate of use was 41% of 3,225 patients in 1990, and 45% of 3,736 patients in 1991. In both study years, patient age was strongly correlated with the likelihood of undergoing conservative surgery, with younger women more frequently treated with this approach. In each province, patients treated at centers located in the main city had a greater probability (OR, 1.54; 95% Cl, 1.37–1.69) of having conservative surgery. This procedure was also more often used in private hospitals (OR, 1.59; 95% Cl, 1.20–2.08) where care is paid at the point of consumption by patients, directly or through their private insurance. The observed variation in the use of the conservative procedure across the 10 regional areas was greater than that expected by chance alone (p <.0001), with rates ranging from 29% to 60%. This pattern persisted even after adjusting for the relevant patient and hospital characteristics. Despite the relatively large body of scientific evidence, it appears that the surgical management of breast cancer is more dependent on physicians' attitudes in each geographic area than on individual patients' characteristics.

Type
General Essays
Information
International Journal of Technology Assessment in Health Care , Volume 11 , Issue 4 , Fall 1995 , pp. 733 - 740
Copyright
Copyright © Cambridge University Press 1995

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References

1.Cain, K. C., & Diehr, P.The relationship between small-area variations in the use of health care services and inappropriate use: A commentary. Health Services Research, 1993, 28, 411–18.Google Scholar
2.Chassin, M. R., Brook, R. H., Park, R. E., et al. Variations in the use of medical and surgical services by the medicare population. New England Journal of Medicine, 1986, 314, 285–90.CrossRefGoogle ScholarPubMed
3.Davidson, G.Does inappropriate use explain small-area variations in the use of health care services? A critique. Health Services Research, 1993, 28, 389–410.Google Scholar
4.Diehr, P., Cain, K., Connell, F., & Volinn, E.What is too much variation? The null hypothesis in small-area analysis. Health Services Research, 1990, 24, 741–71.Google ScholarPubMed
5.Farrow, D. C., Hunt, W. C., & Samet, J. M.Geographic variation in the treatment of localized breast cancer. New England Journal of Medicine, 1992, 326, 1097–101.CrossRefGoogle ScholarPubMed
6.Folland, S., & Stano, M.Small area variations: A critical review of propositions, methods, and evidence. Medical Care Review, 1990, 47, 419–65.CrossRefGoogle ScholarPubMed
7.GIVIO (Interdisciplinary Group for Cancer Care Evaluation) Italy. What doctors tell patients with breast cancer about diagnosis and treatment: Findings from a study in general hospitals. British Journal of Cancer, 1986, 54, 319–26.CrossRefGoogle Scholar
8.Grilli, R., A'lexanian, A. A., Apolone, G., et al. Trends in patterns of care for breast cancer in Italy (1979–1987). Tumori, 1990, 76, 184–89.CrossRefGoogle ScholarPubMed
9.Grilli, R., Apolone, G., Marsoni, S., et al. The impact of patient management guidelines on the care of breast, colorectal, and ovarian cancer patients in Italy. Medical Care, 1991, 29, 50–63.CrossRefGoogle ScholarPubMed
10.Iscoe, N. A., Goel, V., Wu, K., et al. Variation in breast cancer surgery in Ontario. Canadian Medical Association Journal, 1994, 150, 345–52.Google ScholarPubMed
11.Kleinbaunm, D. G., Kupper, L. L., & Morgenstern, H.Epidemiologicresearch: Principles and quantitative methods. New York: Van Nostrand Reinhold, 1982.Google Scholar
12.Leape, L. L., Park, R. E., Solomon, D.H., et al. Does inappropriate use explain small-area variation in the use of health care services? Journal of the American Medical Association, 1990, 263, 669–72.CrossRefGoogle ScholarPubMed
13.Lemeshow, S., & Hosmer, D. W.The use of goodness of fit statistics in the development of logistic regression models. American Journal of Epidemiology, 1982, 115, 92–106.CrossRefGoogle ScholarPubMed
14.Libtrati, A.Progetto oncologia femminile. Un contributo al trasferimento delle conoscenze in oncologia. Roma: Ministero della Sanitá, 1991.Google Scholar
15.Liberati, A., Apolone, G., Nicolucci, A., et al. The role of attitudes, beliefs, and personal characteristics of Italian physicians in the surgical treatment of early breast cancer. American Journal of Public Health, 1990, 81, 38–42.CrossRefGoogle Scholar
16.Mueller, C. B.Lumpectomy: Who is eligible? Surgery, 1986, 100, 584–85.Google ScholarPubMed
17.Nattmger, A. B., Gottlieb, M. S., Veum, J., et al. Geographic variation in the use of breast-conserving treatment for breast cancer. New England Journal of Medicine, 1992, 326, 1102–07.CrossRefGoogle Scholar
18.Nicolucci, A., Mainini, F., Penna, A., et al. The influence of patient characteristics on the appropriateness of surgical treatment for breast cancer patients. Annals of Oncology, 1993, 4, 133–40.CrossRefGoogle ScholarPubMed
19.Poledna'k, A. P.Geographic variation in the treatment of prostate cancer in Connecticut. International Journal of Technology Assessment in Health Care, 1993, 9, 304–10.CrossRefGoogle Scholar
20.Surbone, A.Truth telling to the patient. Journal of the American Medical Association 1992, 268, 1661–62.CrossRefGoogle ScholarPubMed
21.Udaya Kumar, T. M., Al-Asadi, A., & Mosley, J. G.Which women prefer which treatment for breast cancer. Breast, 1992, 1, 193–95.CrossRefGoogle Scholar
22.Veronesi, U., Saccozzi, R., Del Vecchio, M., et al. Comparing radical mastectomy with quadrantectomy, axillary dissection, and radiotherapy in patients with small cancers of the breast. New England Journal of Medicine, 1981, 305, 6–11.CrossRefGoogle ScholarPubMed
23.Wennberg, J.Which rate is right? New England Journal of Medicine, 1986, 314, 310–11.CrossRefGoogle ScholarPubMed