This blog is part of our series on the issues related to the transferability of outcomes, for National decision making. You can follow this link to read our other posts within this topic.
To illustrate the impact and the role of healthcare delivery, this blog refers to an example in Breast Cancer based on the publication, “Relative Effectiveness in Breast Cancer Treatment: A Health Production Approach”. This publication carried out an evaluation of reasons why the relative effectiveness might vary across healthcare systems, based on literature and clinical guidelines. Below is a summary of the factors indicated in this publication which affect breast cancer outcomes.
The paper includes additional information about each category and the supporting studies. Interestingly, it provides very limited information about the actual delivery of healthcare, other than indirect numbers. Reason being that there is limited research on the topic.
Referring to the flow-chart below, it is taken from a previous project we did in breast cancer. It is one of more than 20 flow-charts describing the pathway of breast cancer patients (not all other flow-charts are as complex).
The question is then, to what extent does the delivery of healthcare differ, compared to the national guidelines which are frequently suggested as a method to compare how healthcare is delivered. Through the rich data within Swedish Breast Cancer, we have the ability to evaluate the different healthcare delivery approaches across many regions and how this evolves over time.
Timing from diagnosis to treatment has crucial impact on the outcomes
In this example, you can see the difference in timing in a few key-activities of breast cancer treatment across regions in Sweden. Noticeably, these factors impact the overall outcome of the disease.
Data is extracted from the National Breast Cancer Registry (link).
Difference in Health Care Delivery
One would expect that the same treatment would be provided, even though timing is different. However, as illustrated by these examples, there is a significant variability.
Data is extracted from the National Breast Cancer Registry (link).
Concluding remarks
Considering these examples in breast cancer, there is limited research about the impact of healthcare delivery. In the Swedish examples, it demonstrates a broad variation in the variables related to healthcare delivery. Therefore, as a way forward, in the coming blogposts we will link this result to the impact it has on the outcomes.
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