title: Referral by outreach specialist reduces hospitalisation costs of rural patients with digestive tract cancer: a report from medical consortium in China.
abstract: BACKGROUND
  The authors examined the effect of referrals from outreach specialists on total hospitalisation costs of rural Chinese patients receiving surgical treatment for digestive tract cancer at a tertiary hospital within a vertically integrated medical consortium.
  
  
  METHODS
  A retrospective cohort study was conducted within the Taiyuan Central Hospital medical consortium between January 2008 and December 2010. This consortium consists of Taiyuan Central Hospital (a tertiary hospital) and three county hospitals in Taiyuan city, the capital of Shanxi province in China. Patients admitted for surgery to treat digestive tract cancer (N=359) were assigned to control (direct admission without referral), referral by local doctor (RL), or referral by outreach specialist (RO) groups according to referral type. Length of stay (LOS) and hospitalisation costs were examined. Regression-adjusted costs were estimated by a multivariate model that controlled for gender, age, type of cancer, Charlson Comorbidity Index (CCI) score, and referral type.
  
  
  RESULTS
  Significant differences were found between the three groups (p<0.001) for LOS and total hospitalisation costs. Both were highest for the control group, followed by RL and then the RO groups (LOS: 28.3 ± 4.9, 24.2 ± 5.9, and 19.2 ± 3.7 days; hospitalisation cost: Chinese yuan (CNY)35,087.87 ± 6208.30, 32,853.38 ± 5195.40, and 29,794.56 ± 5250.20).
  
  
  CONCLUSIONS
  A strong association was found between RO and substantially reduced hospitalisation costs in patients receiving digestive tract cancer surgery within the medical consortium as compared to RL. This finding suggests that the strengthened collaboration between outreach specialists and local doctors, herein referred to as the green referral channel, is the key factor leading to reduced hospitalisation costs.
authors.affiliation: Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. shige1159@xinhuamed.com.cn.
authors.forename: Ge
authors.initials: G
authors.lastname: Shi
authors.affiliation: Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. buffott1703@yahoo.com.cn.
authors.forename: Bin
authors.initials: B
authors.lastname: Zhou
authors.affiliation: Chongming Health Bureau, Shanghai, China. francecai@sohu.com.
authors.forename: Zhi-Chang
authors.initials: ZC
authors.lastname: Cai
authors.affiliation: Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. mazuiwu88@hotmail.com.
authors.forename: Tao
authors.initials: T
authors.lastname: Wu
authors.affiliation: Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. lixianfengsir@163.com.
authors.forename: Xian-Feng
authors.initials: XF
authors.lastname: Li
authors.affiliation: Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. wgxu@xinhuamed.com.cn.
authors.forename: Weiguo
authors.initials: W
authors.lastname: Xu
mesh_terms: D000367:Age Factors; D000818:Animals; D002415:Cats; D002681:China; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000191:economics* / Q000601:surgery*; D017721:Hospital Costs / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012017:Referral and Consultation / Q000458:organization & administration*; D012189:Retrospective Studies; D019035:Rural Health Services / Q000191:economics / Q000458:organization & administration*; D012737:Sex Factors; D012959:Socioeconomic Factors; D013038:Specialization