title: The impact of the 'hub and spoke' model of care for lung cancer and equitable access to surgery.
abstract: OBJECTIVE
  To determine the influence of where a patient is first seen (either surgical or non-surgical centre) and patient features on having surgery for non-small cell lung cancer (NSCLC).
  
  
  METHODS
  Cross-sectional study from individual patients, between 1January 2008 and 31March 2012.
  
  
  METHODS
  Linked National Lung Cancer Audit and Hospital Episode Statistics datasets.
  
  
  METHODS
  95,818 English patients with a diagnosis of NSCLC, of whom 12,759 (13%) underwent surgical resection.
  
  
  METHODS
  Odds of having surgery based on the empirical catchment population of the 30 thoracic surgical centres in England and whether the patient is first seen in a surgical centre or a non-surgical centre.
  
  
  RESULTS
  Patients were more likely to be operated on if they were first seen at a surgical centre (OR 1.37; 95% CI 1.29 to 1.45). This was most marked for surgical centres with the largest catchment populations. In these surgical centres with large catchment populations, the resection rate for local patients was 18% and for patients first seen in a non-surgical centre within catchment was 12%.
  
  
  CONCLUSIONS
  Surgical centres that serve the largest catchment populations have high resection rates for patients first seen in their own centre but, in contrast, low resection rates for patients first seen at the surrounding centres they serve. Our findings demonstrate the importance of going further than relating resection rates to hospital volume or surgeon number, and show that there is a pressing need to design lung cancer services which enable all patients, including those first seen at non-surgical centres, to have equal access to lung cancer surgery.
authors.affiliation: Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK.
authors.forename: Aamir
authors.initials: A
authors.lastname: Khakwani
authors.affiliation: Department of Respiratory Medicine, Nottingham University Hospitals, Nottingham, UK.
authors.forename: Anna L
authors.initials: AL
authors.lastname: Rich
authors.affiliation: Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK Nottingham Respiratory Research Unit, University of Nottingham, Nottingham, UK.
authors.forename: Helen A
authors.initials: HA
authors.lastname: Powell
authors.affiliation: Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK.
authors.forename: Laila J
authors.initials: LJ
authors.lastname: Tata
authors.affiliation: Falls and Fragility Audit Programme Manager Clinical Effectiveness and Evaluation Unit, Royal College of Physicians, London, UK.
authors.forename: Rosamund A
authors.initials: RA
authors.lastname: Stanley
authors.affiliation: Department of Respiratory Medicine, Nottingham University Hospitals, Nottingham, UK.
authors.forename: David R
authors.initials: DR
authors.lastname: Baldwin
authors.affiliation: Department of Thoracic Surgery, Nottingham University Hospitals, Nottingham, UK.
authors.forename: John P
authors.initials: JP
authors.lastname: Duffy
authors.affiliation: Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK Nottingham Respiratory Research Unit, University of Nottingham, Nottingham, UK.
authors.forename: Richard B
authors.initials: RB
authors.lastname: Hubbard
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000601:surgery*; D002391:Catchment Area, Health / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D004739:England; D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration / Q000706:statistics & numerical data*; D006782:Hospitals, Special / Q000706:statistics & numerical data*; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational; D062072:Patient Acuity; D011013:Pneumonectomy / Q000706:statistics & numerical data*; D012737:Sex Factors; D013903:Thoracic Surgery
keywords: Lung Cancer; Non-Small Cell Lung Cancer; Thoracic Surgery