Toward a Consensus on Centralization in Surgery
The result's identifiers
Result code in IS VaVaI
<a href="https://www.isvavai.cz/riv?ss=detail&h=RIV%2F00216208%3A11130%2F18%3A10387155" target="_blank" >RIV/00216208:11130/18:10387155 - isvavai.cz</a>
Result on the web
<a href="https://doi.org/10.1097/SLA.0000000000002965" target="_blank" >https://doi.org/10.1097/SLA.0000000000002965</a>
DOI - Digital Object Identifier
<a href="http://dx.doi.org/10.1097/SLA.0000000000002965" target="_blank" >10.1097/SLA.0000000000002965</a>
Alternative languages
Result language
angličtina
Original language name
Toward a Consensus on Centralization in Surgery
Original language description
Objectives: To critically assess centralization policies for highly specialized surgeries in Europe and North America and propose recommendations. Background/Methods: Most countries are increasingly forced to maintain quality medicine at a reasonable cost. An all-inclusive perspective, including health care providers, payers, society as a whole and patients, has ubiquitously failed, arguably for different reasons in environments. This special article follows 3 aims: first, analyze health care policies for centralization in different countries, second, analyze how centralization strategies affect patient outcome and other aspects such as medical education and cost, and third, propose recommendations for centralization, which could apply across continents. Results: Conflicting interests have led many countries to compromise for a health care system based on factors beyond best patient-oriented care. Centralization has been a common strategy, but modalities vary greatly among countries with no consensus on the minimal requirement for the number of procedures per center or per surgeon. Most national policies are either partially or not implemented. Data overwhelmingly indicate that concentration of complex care or procedures in specialized centers have positive impacts on quality of care and cost. Countries requiring lower threshold numbers for centralization, however, may cause inappropriate expansion of indications, as hospitals struggle to fulfill the criteria. Centralization requires adjustments in training and credentialing of general and specialized surgeons, and patient education. Conclusion/Recommendations: There is an obvious need in most areas for effective centralization. Unrestrained, purely "market driven'' approaches are deleterious to patients and society. Centralization should not be based solely on minimal number of procedures, but rather on the multidisciplinary treatment of complex diseases including well-trained specialists available around the clock. Audited prospective database with monitoring of quality of care and cost are mandatory.
Czech name
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Czech description
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Classification
Type
J<sub>imp</sub> - Article in a specialist periodical, which is included in the Web of Science database
CEP classification
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OECD FORD branch
30212 - Surgery
Result continuities
Project
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Continuities
I - Institucionalni podpora na dlouhodoby koncepcni rozvoj vyzkumne organizace
Others
Publication year
2018
Confidentiality
S - Úplné a pravdivé údaje o projektu nepodléhají ochraně podle zvláštních právních předpisů
Data specific for result type
Name of the periodical
Annals of Surgery
ISSN
0003-4932
e-ISSN
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Volume of the periodical
268
Issue of the periodical within the volume
5
Country of publishing house
US - UNITED STATES
Number of pages
13
Pages from-to
712-724
UT code for WoS article
000452663900002
EID of the result in the Scopus database
2-s2.0-85054764994