Abstract:
OBJECTIVE:The effects of demographic, locational and socio-economic disadvantage, and the influence of private health care on five-year mortality rates in patients with lung cancer or after breast cancer surgery in Western Australia were examined. METHODS:The Western Australian Record Linkage Project was used to extract all hospital morbidity, cancer and death records of all people with lung or breast cancer in Western Australia from 1982 to 1996. Mortality rate ratios after a diagnosis of lung cancer or breast cancer surgery were estimated using Cox regression. Two sets of analyses were carried out: demographically adjusted from 1982 to 1996; and demographically and disadvantage adjusted from 1992 to 1996. RESULTS:Overall, 87.7% of lung cancer and 17.8% of breast cancer patients were deceased by five years. Lung and breast cancer patients treated in rural hospitals had higher mortality rates (1992-1996: relative risk (RR) 1.24, 95% confidence interval (CI) 1.07-1.44, and RR 1.20, 95% CI 0.92-1.56, respectively; 1982-1996: RR 1.20, 95% CI 1.11-1.30, and RR 1.19, 95% CI 1.06-1.33, respectively), whereas location of residence had little effect. Lung and breast cancer patients treated in private hospitals had lower mortality (1992-1996: RR 0.85, 95% CI 0.76-0.95, and RR 0.90, 95% CI 0.77-1.05, respectively; 1982-1996: RR 0.91, 95% CI 0.84-0.97, and RR 0.92, 95% CI 0.85-0.99, respectively), although insurance status was not a factor. Women with breast cancer had significantly worse survival in the more socio-economically disadvantaged groups (1992-1996: RR 1.41 to 1.26; 1982-1996: RR 1.45 to 1.29). CONCLUSIONS:Survival was poorer in patients treated in the public hospital system, but the possession of private health insurance was not predictive of better outcomes. People treated in rural hospitals had worse survival, whereas location of residence was not an independent factor. Women in more socio-economically advantaged groups who underwent breast cancer surgery had improved survival.
journal_name
J Health Serv Res Policyjournal_title
Journal of health services research & policyauthors
Hall S,Holman CD,Sheiner H,Hendrie Ddoi
10.1258/1355819042248116subject
Has Abstractpub_date
2004-10-01 00:00:00pages
10-6eissn
1355-8196issn
1758-1060journal_volume
9 Suppl 2pub_type
杂志文章abstract::The economic evaluation of health care technologies has a key role within the new National Health Service health technology assessment process. There has, however, been little discussion of the best way of combining economic and clinical research. Economic evaluation should be iterative, generating progressively firme...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1177/135581969700200107
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abstract::Hospitals are awash with patient experience data, much of it collected with the ostensible purpose of improving the quality of patient care. However, there has been comparatively little consideration of the nature and capacities of data itself. Using insights from actor-network theory, we propose that paying attention...
journal_title:Journal of health services research & policy
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abstract:OBJECTIVES:To estimate the costs and potential efficiency gains of changing the frequency of clinic appointments and drug dispensing arrangements for stable HIV patients compared to the costs of hospital pharmacy dispensing and home delivery. METHODS:We estimated the annual costs per patient (HIV clinic visits and eit...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1177/1355819613508176
更新日期:2014-07-01 00:00:00
abstract::This paper analyses likely implications of two recent European Court rulings on the provision of health care across borders within the European Union. We argue that the two cases have fundamental implications for the provision of health services as free access to care across borders conflicts with the principle of sub...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1177/135581960000500408
更新日期:2000-10-01 00:00:00
abstract::The rationales used in chiropractic are largely in keeping with current evidence-based guidance. When listening to debates for and against the scientific basis of chiropractic, it is important to be aware of the selective use of evidence on both sides and of the limitations of logical positivistic arguments when it co...
journal_title:Journal of health services research & policy
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doi:10.1258/jhsrp.2009.009025
更新日期:2009-07-01 00:00:00
abstract:OBJECTIVE:To explore some of the impacts of star performance ratings in acute hospital trusts in England. METHODS:A multiple case study design was used which incorporated purposeful sampling of 'low' and 'high' performing trusts using the star rating system. In each case study site, data collection comprised semi-stru...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1177/135581960501000106
更新日期:2005-01-01 00:00:00
abstract:INTRODUCTION:Levels of management staffing in the UK National Health Service (NHS) have received considerable political and media attention in the last four years or so. Both the previous and current governments committed themselves to reducing management expenditure in the health service, and significant cuts appear t...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1177/135581969900400104
更新日期:1999-01-01 00:00:00
abstract:BACKGROUND AND PURPOSE:The assessment of any health care intervention should consider both risks and benefits and take patients' preferences about these into account. The study reported in this paper aimed to elicit patient valuations of health states relevant to assessment of the prevention of stroke by warfarin antic...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1258/1355819011927288
更新日期:2001-04-01 00:00:00
abstract:OBJECTIVES:To explore the relationship between ethnicity, socioeconomic deprivation and utilization of general practice. METHODS:Data routinely collected by New Zealand general practices in 2001 were analysed using generalized linear regression. RESULTS:The mean number of doctor consultations for registered individua...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1258/135581906777641721
更新日期:2006-07-01 00:00:00
abstract:OBJECTIVES:The introduction of an internal market in the British National Health Service (NHS) has highlighted the importance of developing appropriate, valid and timely measures of hospital activity, both for the purposes of specifying and monitoring contracts and for evaluating the success of the NHS reforms in gener...
journal_title:Journal of health services research & policy
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doi:10.1177/135581969600100104
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abstract:OBJECTIVE:To explore the tensions across the primary-secondary interface when referral from primary care is to a team and to inform service developments in other specialties. METHODS:A nested qualitative study within a randomized controlled trial of primary care and Community Mental Health Teams (CMHTs) in Croydon and...
journal_title:Journal of health services research & policy
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1258/jhsrp.2007.006053
更新日期:2008-01-01 00:00:00
abstract:OBJECTIVE:the nature of care delivered in emergency departments has changed due to increased demand. In response, one relatively new change is the introduction of a physiotherapy service. There have been anecdotal reports that this may reduce patient waiting times and lead to more effective use of other health care sta...
journal_title:Journal of health services research & policy
pub_type: 杂志文章,评审
doi:10.1258/jhsrp.2010.009129
更新日期:2011-01-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:Automated pharmacy data have been used to develop a measure of chronic disease status in the general population. The objectives of this project were to refine and apply a model of chronic disease identification using Italian automated pharmacy data; to describe how this model may identify patt...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1258/135581905774414259
更新日期:2005-10-01 00:00:00
abstract::This paper takes an overview of the organizational and managerial literature on recent large-scale change efforts within health care organizations. Such literature refers to issues of enhanced policy significance, as a succession of such changes has swept through health care, at an international level. Interpretive an...
journal_title:Journal of health services research & policy
pub_type: 杂志文章,评审
doi:10.1177/135581969700200310
更新日期:1997-07-01 00:00:00
abstract:OBJECTIVES:To evaluate the effect of a risk factor checklist and training video for general practitioners in reducing inter-practice variation and improving the appropriateness of referrals (assessed by their positive predictive value or PPV) of patients with suspected otitis media with effusion (OME or 'glue ear') to ...
journal_title:Journal of health services research & policy
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1258/1355819011927387
更新日期:2001-07-01 00:00:00
abstract:OBJECTIVES:To assess the role of economics, in combination with clinical judgement, for setting research priorities, using osteoporosis prevention (and, as a result, hip fracture prevention) as an example. METHODS:Modelling the cost and effectiveness of each of six potential interventions to prevent hip fractures over...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1177/135581969600100305
更新日期:1996-07-01 00:00:00
abstract:OBJECTIVES:English primary care organisations (primary care groups and trusts - PCGs, PCTs) were, and are, responsible for the quality of general practice but lack hierarchical structures and, frequently, contractual relationships through which to influence it. The theory of soft governance describes how managers can i...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1258/1355819041403295
更新日期:2004-07-01 00:00:00
abstract:OBJECTIVE:To evaluate the effectiveness and cost of obtaining consent for review of medical records within the passively observed non-intervention arm of a cluster randomized controlled trial, 'Comparison Arm for ProtecT'. METHODS:Two hundred and thirty men, who had been notified to the trial by cancer registries as h...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1258/jhsrp.2008.008085
更新日期:2009-04-01 00:00:00
abstract:OBJECTIVE:Non-surgical treatment can be effective for many musculoskeletal conditions. Improving access to these options may improve the efficiency of hospitals. The Orthopaedic Physiotherapy Screening Clinic and Multidisciplinary Service offers early comprehensive assessment and coordinated, patient-centred care withi...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1177/1355819614533675
更新日期:2014-10-01 00:00:00
abstract:OBJECTIVE:To evaluate how UK maternity unit protocols conformed to national recommendations for preventing early-onset neonatal Group B Streptococcal (GBS) disease. METHODS:In December 2005, all UK obstetric maternity units were contacted and asked to provide a copy of their protocol on preventing GBS disease. Informa...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1258/jhsrp.2007.007144
更新日期:2008-04-01 00:00:00
abstract::It is important to include non English speakers in health services research to ensure not only the generalisability of findings but also to address health inequalities and promote social justice. One approach is to use interpreters but there is little guidance for working with an interpreter in interviews. Involving a...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1258/JHSRP.2012.012003
更新日期:2012-07-01 00:00:00
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journal_title:Journal of health services research & policy
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更新日期:2005-04-01 00:00:00
abstract::Policy-makers and managers have always used a wide range of sources of evidence in making decisions about policy and the organization of services. However, they are under increasing pressure to adopt a more systematic approach to the utilization of the complex evidence base. Decision-makers must address complicated qu...
journal_title:Journal of health services research & policy
pub_type: 杂志文章,评审
doi:10.1258/1355819054308576
更新日期:2005-07-01 00:00:00
abstract:OBJECTIVE:Cost-utility analysis is gaining importance as a tool for setting priorities in health care. The approach requires quality-of-life weights on a scale from 0.00 (corresponding to death) to 1.00 (corresponding to perfect health). Different methods and perspectives of the evaluators tend to give different result...
journal_title:Journal of health services research & policy
pub_type: 杂志文章,评审
doi:10.1258/135581904322716111
更新日期:2004-01-01 00:00:00
abstract:OBJECTIVES:To critically evaluate the quality of hospital medical care at the beginning, during and shortly after regionalization of health boards in Newfoundland and Labrador, and aggregation of hospitals in the St John's region. METHODS:Retrospective chart audits for the years 1995/96, 1998/99 and 2000/01 (at the be...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1258/135581905774424465
更新日期:2005-10-01 00:00:00
abstract::'Integrated care' is pitched as the solution to current health system challenges. In the literature, what integrated care actually involves is complex and contested. Multi-disciplinary team case management is frequently the primary focus of integrated care when implemented internationally. We examine the practical app...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1177/1355819616660581
更新日期:2016-10-01 00:00:00
abstract::Diagnosis-related groups are widespread across Europe and they are meant to be a central instrument to improve the activity and efficiency of hospitals. However, there are many examples of diagnosis-related groups having adverse effects which are difficult to control and which endanger the goals of health care systems...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1177/1355819615586444
更新日期:2016-01-01 00:00:00
abstract:BACKGROUND:Improvements in health service provision need not be costly and indeed may save money. Administration of radio iodine ((131)I) to patients with thyrotoxicosis in the UK is often delayed because few endocrinologists have appropriate Administration of Radioactive Substances Advisory Committee (ARSAC) certifica...
journal_title:Journal of health services research & policy
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更新日期:2007-10-01 00:00:00
abstract::We review the foundations of resource allocation rules based on cost-effectiveness information. Comprehensive approaches, where a total budget is allocated in one go, require estimation of the costs and effects of all available health care programmes, which is unlikely to be practical. A common alternative is to asses...
journal_title:Journal of health services research & policy
pub_type: 杂志文章,评审
doi:10.1258/1355819042250177
更新日期:2004-10-01 00:00:00
abstract:OBJECTIVE:Effective use of staff is a major aim in all health-care systems both to maximize their impact and to minimize costs. In England, a few general practitioners (GPs) have been recruiting physician assistants (PAs) to work in their practices, independent of any pilot schemes. Our objective was to study the motiv...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1258/jhsrp.2010.010061
更新日期:2011-04-01 00:00:00