[Centralisation of breast cancer management by giving minimum work-load. Empirical effects in the region of North-Rhine, Germany].
BACKGROUND
The concentration of treatment on a few hospitals is discussed to improve the outcome of care. For the treatment of the breast cancer the distributional effects are evaluated.


METHODS
A systematic literature search in Medline identified six studies dealing with the evidence on the relation between outcome and workload. Using administrative data of a sickness fund in the region of Rhineland, Germany, the number of hospitals and patients affected by minimum work-loads was determined.


RESULTS
Study results show that in general a minimum workload of 100 to 150 new diagnosed cases per year and hospital is recommended. These recommendations would lead to 46% of the presently treating hospitals being excluded (minimum work-load of 150 cases; year 2001). If the workload is set to 100 cases, 31% of the hospitals will be excluded from breast cancer management. No significant differences could be detected in the data of the years 2000 and 2001.


CONCLUSIONS
The association between minimum workload and outcome of care seems to be evident. Further studies involving larger regions are needed to evaluate the distributional effects and gains of outcome.
Institut für Gesundheitsökonomie und Klinische Epidemiologie der Universität zu Köln. Luengen@igke.de
Markus
M
Lüngen
Christoph J
CJ
Rupprecht
Evelyn
E
Plamper
Karl W
KW
Lauterbach
D001943:Breast Neoplasms / Q000628:therapy*; D005260:Female; D005858:Germany; D006801:Humans; D016239:MEDLINE; D008495:Medical Oncology / Q000706:statistics & numerical data; D016896:Treatment Outcome; D016526:Workload / Q000706:statistics & numerical data