Josep A Espinas | Catalan Institute of Oncology (original) (raw)
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Papers by Josep A Espinas
International Journal of Technology Assessment in Health Care, 1998
A breast cancer screening program mainly aims at reducing mortality. However, it also has an effe... more A breast cancer screening program mainly aims at reducing mortality. However, it also has an effect, often not assessed, on the utilization of health care resources that is relevant to health care policy making. Using a simulation model, this paper forecasts the impact of introducing a breast cancer screening program on the utilization of resources for the primary therapy of breast cancer. The most important consequences from a health care point of view will be an increased use of breast-conserving therapy and an increased need for postoperative radiotherapy; there will also be a higher number of women diagnosed with noninvasive breast cancer. The results of this study could provide support for health care decision making by showing the consequences of policy decisions on the introduction of screening programs for health care utilization.
International Journal of Technology Assessment in Health Care, 1997
International Journal of Technology Assessment in Health Care, 13:2 (1997), 220-286. Copyright © ... more International Journal of Technology Assessment in Health Care, 13:2 (1997), 220-286. Copyright © 1997 Cambridge University Press. Printed in the USA ... Dr. Alicia Granados, Co-Chair, Catalan Agency for Health Technology Assessment (CAHTA), Barcelona, Spain; Professor Egon ...
European Journal of Cardio-thoracic Surgery, 1997
Objecti6e: To develop a risk stratification model to assess open heart surgery mortality in Catal... more Objecti6e: To develop a risk stratification model to assess open heart surgery mortality in Catalonia (Spain) in order to use risk-adjusted hospital mortality rates as an approach to analyze quality of care. Methods: Data were prospectively collected through a specific data-sheet during 6 1 2 months in consecutive adult patients subjected to open heart surgery. The dependent variable was surgical mortality, and independent variables included were presurgical (sociodemographic data, clinical antecedents, morphological and functional studies) and surgical. The model was built on a subsample (70% of study population) through univariate and logistic regression analysis and validated in the rest of the sample. Results: The total sample was of 1309 procedures in seven hospitals; 47% of them were valve procedures. The overall crude mortality rate was 10.9% and varied among centers (range, 2.8-14.8%). Risk factors included in the model received a weight based on the logistic regression coefficient and a score was generated for each patient. The factors with the highest weight were patient older than 80 and second reoperation. Score was stratified in five categories of increasing risk. There was a good agreement between observed and predicted mortality rates in the validation group. Overall patient distribution was as follows: 52% low risk level, 16% fair, 13% high, 12% very high, and 6% extremely high risk level. Mortality rate increased from 4.2% in the low risk to 54.4% in the highest risk group. Case mix adjustment was performed through the risk score level. There were statistically significant differences in the risk profiles of patients admitted among centers. After adjustment by risk profiles, there were no differences in mortality by hospital. Conclusion: A risk stratification model through a multicentric, prospective and exhaustive collection of data in all types of open heart procedures was developed. In spite of wide differences on crude rates and in the risk profiles of patients admitted, we did not find statistically significant differences in adjusted mortality rates among centers. Timely and accurate information about surgical outcomes can lead to improvements in clinical practice and quality of care. © 1997 Elsevier Science B.V.
surgical procedures Subjective versus statistical model assessment of mortality risk in open hear... more surgical procedures Subjective versus statistical model assessment of mortality risk in open heart http://ats.ctsnetjournals.org/cgi/content/full/67/3/635 on the World Wide Web at: The online version of this article, along with updated information and services, is located Print ISSN: 0003-4975; eISSN: 1552-6259. Southern Thoracic Surgical Association. Background. The aim of this study was to compare the predictive accuracy for open heart surgical mortality between a statistical model based on collection of clinical data and surgeons' subjective risk assessment.
Annals of Thoracic Surgery, 1999
surgical procedures Subjective versus statistical model assessment of mortality risk in open hear... more surgical procedures Subjective versus statistical model assessment of mortality risk in open heart http://ats.ctsnetjournals.org/cgi/content/full/67/3/635 on the World Wide Web at: The online version of this article, along with updated information and services, is located Print ISSN: 0003-4975; eISSN: 1552-6259. Southern Thoracic Surgical Association. Background. The aim of this study was to compare the predictive accuracy for open heart surgical mortality between a statistical model based on collection of clinical data and surgeons' subjective risk assessment.
Radiotherapy and Oncology, 2011
Aim: To ascertain the degree of adherence to the guideline recommendation on pre-operative RT/ChT... more Aim: To ascertain the degree of adherence to the guideline recommendation on pre-operative RT/ChT for stage-II and -III patients in Catalonian public hospitals, and its impact on local recurrence among rectal cancer patients. Methods: Data were derived from a multicentre retrospective cohort study of patients who underwent curative-intent surgery for primary rectal cancer at Catalonian public hospitals in 2005 and 2007. Results: The study covered 1229 patients with TNM stage-II or -III primary rectal cancer. Of these patients, 54.5% underwent pre-operative RT/ChT; 14.9% underwent post-operative RT (± chemotherapy); and 30.6% did not undergo any RT. The crude local recurrence rate at 2 years was 4.1% and the crude distant recurrence rate at 2 years was 6.5%. The results of the univariate analyses showed a local-recurrence hazard ratio of 1.84 for the group of patients that received no RT versus the group that received pre-operative RT/ChT (p < 0.01). Conclusions: This is the first population-based study in Catalonia to support the use of pre-operative RT/ ChT in rectal cancer patients because, in line with the results of population-based studies reported from other countries, its application, compared to non-application of RT, was found to lead to a clear reduction in the probability of local recurrence.
Ejso, 2011
Clinical practice guidelines in cancer are a relevant component of Catalonian Cancer Strategy aim... more Clinical practice guidelines in cancer are a relevant component of Catalonian Cancer Strategy aimed at promoting equity of access to therapy and quality of cancer care. The colorectal cancer (CRC) guideline was first published in 2003 and subsequently updated in 2008. This study examined the quality of therapy administered to patients with rectal cancer in public hospitals in Catalonia (Spain) in 2005 and 2007, according to CRC guideline recommendations. We conducted a multicentre retrospective cohort study of patients who underwent curative-intent surgery for primary rectal cancer at Catalonian public hospitals in 2005 and 2007. Data were drawn from clinical records. The study covered 1831 patients with rectal cancer. Performance of total mesorectal excision (TME) was poorly reported by surgeons (46.4%) and pathologists (36.2%). Pre-operative radiotherapy was performed on 52% of stage-II and -III patients. Compared to high-caseload hospitals, those with a low caseload (≤11 cases/year) registered more Hartman's procedures, worse TME quality, a higher rate of post-operative complications and lower adherence to recommended pre-operative radio-chemotherapy. Reporting quality of care is essential for ascertaining current performance status and opportunities for improvement. In our case, there is a need for the quality of the information included in clinical records to be improved, and variability in adherence to guideline recommendations to be reduced. In view of the fact that heterogeneity in the quality of the health care process was linked to hospital caseload, the health authorities have decided to reorganise the provision of rectal cancer care.
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Ejso, 2011
Corrigendum to 'Variability in the quality of rectal cancer care in public hospitals in Catalonia... more Corrigendum to 'Variability in the quality of rectal cancer care in public hospitals in Catalonia (Spain): Clinical audit as a basis for action' [Eur J Surg Onc. 37 The authors regret that an error occurred in the section 'Policy implications' within this article. In this section, where it was stated 'This measure will reduce the number of hospitals performing rectal surgery to 12.' this should have read 'This measure will reduce the number of hospitals performing rectal surgery by 12.'
British Medical Journal, 2001
Objective To compare chemotherapy given at home with outpatient treatment in terms of colorectal ... more Objective To compare chemotherapy given at home with outpatient treatment in terms of colorectal cancer patients' safety, compliance, use of health services, quality of life, and satisfaction with treatment.
International Journal of Technology Assessment in Health Care, 1998
A breast cancer screening program mainly aims at reducing mortality. However, it also has an effe... more A breast cancer screening program mainly aims at reducing mortality. However, it also has an effect, often not assessed, on the utilization of health care resources that is relevant to health care policy making. Using a simulation model, this paper forecasts the impact of introducing a breast cancer screening program on the utilization of resources for the primary therapy of breast cancer. The most important consequences from a health care point of view will be an increased use of breast-conserving therapy and an increased need for postoperative radiotherapy; there will also be a higher number of women diagnosed with noninvasive breast cancer. The results of this study could provide support for health care decision making by showing the consequences of policy decisions on the introduction of screening programs for health care utilization.
International Journal of Technology Assessment in Health Care, 1997
International Journal of Technology Assessment in Health Care, 13:2 (1997), 220-286. Copyright © ... more International Journal of Technology Assessment in Health Care, 13:2 (1997), 220-286. Copyright © 1997 Cambridge University Press. Printed in the USA ... Dr. Alicia Granados, Co-Chair, Catalan Agency for Health Technology Assessment (CAHTA), Barcelona, Spain; Professor Egon ...
European Journal of Cardio-thoracic Surgery, 1997
Objecti6e: To develop a risk stratification model to assess open heart surgery mortality in Catal... more Objecti6e: To develop a risk stratification model to assess open heart surgery mortality in Catalonia (Spain) in order to use risk-adjusted hospital mortality rates as an approach to analyze quality of care. Methods: Data were prospectively collected through a specific data-sheet during 6 1 2 months in consecutive adult patients subjected to open heart surgery. The dependent variable was surgical mortality, and independent variables included were presurgical (sociodemographic data, clinical antecedents, morphological and functional studies) and surgical. The model was built on a subsample (70% of study population) through univariate and logistic regression analysis and validated in the rest of the sample. Results: The total sample was of 1309 procedures in seven hospitals; 47% of them were valve procedures. The overall crude mortality rate was 10.9% and varied among centers (range, 2.8-14.8%). Risk factors included in the model received a weight based on the logistic regression coefficient and a score was generated for each patient. The factors with the highest weight were patient older than 80 and second reoperation. Score was stratified in five categories of increasing risk. There was a good agreement between observed and predicted mortality rates in the validation group. Overall patient distribution was as follows: 52% low risk level, 16% fair, 13% high, 12% very high, and 6% extremely high risk level. Mortality rate increased from 4.2% in the low risk to 54.4% in the highest risk group. Case mix adjustment was performed through the risk score level. There were statistically significant differences in the risk profiles of patients admitted among centers. After adjustment by risk profiles, there were no differences in mortality by hospital. Conclusion: A risk stratification model through a multicentric, prospective and exhaustive collection of data in all types of open heart procedures was developed. In spite of wide differences on crude rates and in the risk profiles of patients admitted, we did not find statistically significant differences in adjusted mortality rates among centers. Timely and accurate information about surgical outcomes can lead to improvements in clinical practice and quality of care. © 1997 Elsevier Science B.V.
surgical procedures Subjective versus statistical model assessment of mortality risk in open hear... more surgical procedures Subjective versus statistical model assessment of mortality risk in open heart http://ats.ctsnetjournals.org/cgi/content/full/67/3/635 on the World Wide Web at: The online version of this article, along with updated information and services, is located Print ISSN: 0003-4975; eISSN: 1552-6259. Southern Thoracic Surgical Association. Background. The aim of this study was to compare the predictive accuracy for open heart surgical mortality between a statistical model based on collection of clinical data and surgeons' subjective risk assessment.
Annals of Thoracic Surgery, 1999
surgical procedures Subjective versus statistical model assessment of mortality risk in open hear... more surgical procedures Subjective versus statistical model assessment of mortality risk in open heart http://ats.ctsnetjournals.org/cgi/content/full/67/3/635 on the World Wide Web at: The online version of this article, along with updated information and services, is located Print ISSN: 0003-4975; eISSN: 1552-6259. Southern Thoracic Surgical Association. Background. The aim of this study was to compare the predictive accuracy for open heart surgical mortality between a statistical model based on collection of clinical data and surgeons' subjective risk assessment.
Radiotherapy and Oncology, 2011
Aim: To ascertain the degree of adherence to the guideline recommendation on pre-operative RT/ChT... more Aim: To ascertain the degree of adherence to the guideline recommendation on pre-operative RT/ChT for stage-II and -III patients in Catalonian public hospitals, and its impact on local recurrence among rectal cancer patients. Methods: Data were derived from a multicentre retrospective cohort study of patients who underwent curative-intent surgery for primary rectal cancer at Catalonian public hospitals in 2005 and 2007. Results: The study covered 1229 patients with TNM stage-II or -III primary rectal cancer. Of these patients, 54.5% underwent pre-operative RT/ChT; 14.9% underwent post-operative RT (± chemotherapy); and 30.6% did not undergo any RT. The crude local recurrence rate at 2 years was 4.1% and the crude distant recurrence rate at 2 years was 6.5%. The results of the univariate analyses showed a local-recurrence hazard ratio of 1.84 for the group of patients that received no RT versus the group that received pre-operative RT/ChT (p < 0.01). Conclusions: This is the first population-based study in Catalonia to support the use of pre-operative RT/ ChT in rectal cancer patients because, in line with the results of population-based studies reported from other countries, its application, compared to non-application of RT, was found to lead to a clear reduction in the probability of local recurrence.
Ejso, 2011
Clinical practice guidelines in cancer are a relevant component of Catalonian Cancer Strategy aim... more Clinical practice guidelines in cancer are a relevant component of Catalonian Cancer Strategy aimed at promoting equity of access to therapy and quality of cancer care. The colorectal cancer (CRC) guideline was first published in 2003 and subsequently updated in 2008. This study examined the quality of therapy administered to patients with rectal cancer in public hospitals in Catalonia (Spain) in 2005 and 2007, according to CRC guideline recommendations. We conducted a multicentre retrospective cohort study of patients who underwent curative-intent surgery for primary rectal cancer at Catalonian public hospitals in 2005 and 2007. Data were drawn from clinical records. The study covered 1831 patients with rectal cancer. Performance of total mesorectal excision (TME) was poorly reported by surgeons (46.4%) and pathologists (36.2%). Pre-operative radiotherapy was performed on 52% of stage-II and -III patients. Compared to high-caseload hospitals, those with a low caseload (≤11 cases/year) registered more Hartman's procedures, worse TME quality, a higher rate of post-operative complications and lower adherence to recommended pre-operative radio-chemotherapy. Reporting quality of care is essential for ascertaining current performance status and opportunities for improvement. In our case, there is a need for the quality of the information included in clinical records to be improved, and variability in adherence to guideline recommendations to be reduced. In view of the fact that heterogeneity in the quality of the health care process was linked to hospital caseload, the health authorities have decided to reorganise the provision of rectal cancer care.
[
Ejso, 2011
Corrigendum to 'Variability in the quality of rectal cancer care in public hospitals in Catalonia... more Corrigendum to 'Variability in the quality of rectal cancer care in public hospitals in Catalonia (Spain): Clinical audit as a basis for action' [Eur J Surg Onc. 37 The authors regret that an error occurred in the section 'Policy implications' within this article. In this section, where it was stated 'This measure will reduce the number of hospitals performing rectal surgery to 12.' this should have read 'This measure will reduce the number of hospitals performing rectal surgery by 12.'
British Medical Journal, 2001
Objective To compare chemotherapy given at home with outpatient treatment in terms of colorectal ... more Objective To compare chemotherapy given at home with outpatient treatment in terms of colorectal cancer patients' safety, compliance, use of health services, quality of life, and satisfaction with treatment.