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The impact of the ‘hub and spoke’ model of care for lung cancer and equitable access to surgery

Khakwani, Aamir; Rich, Anna L.; Powell, Helen A.; Tata, Laila J.; Stanley, Rosamund A.; Baldwin, David R.; Duffy, John P.; Hubbard, Richard B.

Authors

Aamir Khakwani aamir.khakwani@nottingham.ac.uk

Anna L. Rich

Helen A. Powell

Rosamund A. Stanley

David R. Baldwin

John P. Duffy

RICHARD HUBBARD richard.hubbard@nottingham.ac.uk
Blf/Gsk Professor of Epidemiological Resp Research



Abstract

Objectives: To determine the influence of where a patient is first seen (either surgical or non-surgical centre) and patient features on having surgery for non-small cell lung cancer (NSCLC).

Design: Cross-sectional study from individual patients, between 1January 2008 and 31March 2012.

Setting: Linked National Lung Cancer Audit and Hospital Episode Statistics datasets.

Participants: 95 818 English patients with a diagnosis of NSCLC, of whom 12 759 (13%) underwent surgical resection.

Main outcome measure: Odds of having surgery based on the empirical catchment population of the 30 thoracic surgical centres in England and whether the patient is first seen in a surgical centre or a non-surgical centre.

Results: Patients were more likely to be operated on if they were first seen at a surgical centre (OR 1.37; 95% CI 1.29 to 1.45). This was most marked for surgical centres with the largest catchment populations. In these surgical centres with large catchment populations, the resection rate for local patients was 18% and for patients first seen in a non-surgical centre within catchment was 12%.

Conclusions: Surgical centres that serve the largest catchment populations have high resection rates for patients first seen in their own centre but, in contrast, low resection rates for patients first seen at the surrounding centres they serve. Our findings demonstrate the importance of going further than relating resection rates to hospital volume or surgeon number, and show that there is a pressing need to design lung cancer services which enable all patients, including those first seen at non-surgical centres, to have equal access to lung cancer surgery.

Journal Article Type Article
Publication Date Sep 2, 2014
Journal Thorax
Print ISSN 0040-6376
Electronic ISSN 1468-3296
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed
Volume 70
Issue 2
APA6 Citation Khakwani, A., Rich, A. L., Powell, H. A., Tata, L. J., Stanley, R. A., Baldwin, D. R., …Hubbard, R. B. (2014). The impact of the ‘hub and spoke’ model of care for lung cancer and equitable access to surgery. Thorax, 70(2), https://doi.org/10.1136/thoraxjnl-2014-205841
DOI https://doi.org/10.1136/thoraxjnl-2014-205841
Keywords Lung Neoplasm, Thoracic surgery, Health services, Epidemiology, Non-Small cell lung carcinoma
Publisher URL http://thorax.bmj.com/content/70/2/146
Related Public URLs http://thorax.bmj.com/content/70/2/146.abstract
Copyright Statement Copyright information regarding this work can be found at the following address: http://eprints.nottingh.../end_user_agreement.pdf

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Copyright Statement
Copyright information regarding this work can be found at the following address: http://eprints.nottingham.ac.uk/end_user_agreement.pdf





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