Purpose Regionalization of complex surgery to high-volume hospitals has been advocated based on cross-sectional volume-outcome studies. In April 2007, the agency overseeing cancer care in Ontario, Canada, implemented a policy to regionalize lung cancer surgery at 14 designated hospitals, enforced by economic incentives and penalties. We studied the effects of implementation of this policy. Methods Using administrative health data, we used interrupted time series models to analyze the immediate and delayed effects of implementation of the policy on the distribution of lung cancer surgery among hospitals, surgical outcomes, and health services use. Results From 2004 to 2012, 16,641 patients underwent surgery for lung cancer. The proportion of operations performed in designated hospitals increased from 71% to 89% after the policy was implemented. Although operative mortality decreased from 4.1% to 2.9% (adjusted odds ratio, 0.68; 95% CI, 0.58 to 0.81; P < .001), the reduction was due to a preexisting declining trend in mortality. In contrast, in the years after implementation of the policy, length of hospital stay decreased more than expected from the baseline trend by 7% per year (95% CI, 5% to 9%; P < .001), and the distance traveled by all patients to the hospital for surgery increased by 4% per year (95% CI, 0% to 8%; P = .03), neither of which were explained by preexisting trends. Analyses limited to patients ≥ 70 years of age demonstrated a reduction in operative mortality (odds ratio, 0.80 per year after regionalization; 95% CI, 0.67 to 0.95; P = .01). Conclusion A policy to regionalize lung cancer surgery in Ontario led to increased centralization of surgery services but was not independently associated with improvements in operative mortality. Improvements in length of stay and in operative mortality among elderly patients suggest areas where regionalization may be beneficial.

中文翻译：

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加拿大安大略省肺癌手术的区域化和结果

目的 基于横断面容量结果研究，提倡将复杂手术区域化到大容量医院。2007 年 4 月，加拿大安大略省癌症护理监督机构实施了一项政策，将肺癌手术在 14 家定点医院进行区域化，并通过经济激励和惩罚来实施。我们研究了该政策实施的效果。方法利用行政卫生数据，我们使用间断时间序列模型分析政策实施对肺癌手术在医院中的分布、手术结果和卫生服务使用的即时和延迟影响。结果 2004-2012年，16641例肺癌患者接受了手术治疗。政策实施后，定点医院手术比例从71%提高到89%。尽管手术死亡率从 4.1% 下降到 2.9%（调整后的比值比，0.68；95% CI，0.58 到 0.81；P < .001），但下降的原因是预先存在的死亡率下降趋势。相比之下，在政策实施后的几年中，住院时间比基线趋势每年减少 7%（95% CI，5% 至 9%；P < .001），并且旅行距离超过预期所有到医院接受手术的患者每年增加 4%（95% CI，0% 至 8%；P = .03），这两者都不能用先前存在的趋势来解释。仅限于 70 岁以上患者的分析表明手术死亡率降低（优势比，区域化后每年 0.80；95% CI，0.67 至 0.95；P = .01）。结论 安大略省肺癌手术区域化政策导致了手术服务的集中化，但与手术死亡率的改善并非独立相关。老年患者住院时间和手术死亡率的改善表明区域化可能有益。