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The essential requirements for an HPB centre to deliver high-quality outcomes
Povilas Ignatavicius1, Christian E Oberkofler1, Jan Philipp Jonas1
1Swiss Hepato-Pancreato-Biliary (HPB) Center Zurich, Zurich, Switzerland; Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland.
Insights
High-quality hepato-pancreato-biliary (HPB) centers require more than just caseloads; true integration is key. Many HPB centers are "virtual," lacking dedicated resources, which hinders optimal patient outcomes.
Area of Science:
- Hepatology and Surgical Oncology
- Healthcare Management and Quality Improvement
Background:
- The effectiveness of specialized hepato-pancreato-biliary (HPB) centers for complex disorders is recognized, but essential structural and process requirements for high-quality outcomes are not well-defined.
- Existing literature offers limited data connecting center structure or processes to patient outcomes, beyond caseloads, specialization, and training quality.
Purpose of the Study:
- To identify the essential criteria for establishing high-quality hepato-pancreato-biliary (HPB) centers.
- To evaluate the current state of HPB centers globally and compare it with ideal requirements for optimal patient care.
Main Methods:
- Conducted a comprehensive literature review to identify existing knowledge on HPB center structures and outcomes.
- Performed an international survey of 107 leading HPB centers, gathering insights from experts in HPB surgery.
- Analyzed the long-term experience of a specific Swiss HPB center, examining administrative and budgetary influences on its development.
Main Results:
- The literature review revealed a significant lack of information linking center structure/process to outcomes, with the exception of caseloads, specialization, and training.
- A majority of surveyed HPB centers operate as 'virtual' entities, lacking dedicated physical space, assigned beds, or specialized personnel.
- Hospital administrative priorities and budget constraints can impede the development of fully integrated HPB centers, affecting bed allocation and intermediate care provisions.
Conclusions:
- High-quality HPB care necessitates fully integrated centers, not merely 'virtual' ones.
- Defining and implementing essential structural and resource criteria is crucial for optimizing outcomes in HPB patient care.
- The concept of a 'center of reference' should be reserved for centers with demonstrable, actual integration and dedicated resources.
Abstract:
The concept of a centre approach to the treatment of patients with complex disorders, such as those with hepato-pancreato-biliary (HPB) diseases, is widely applied, although what is needed for an HPB centre to achieve high-quality outcomes remains unclear. We therefore conducted a literature review, which highlighted the paucity of information linking centre structure or process to outcome data outside of caseloads, specialisation, and quality of training. We then conducted an international survey among the largest 107 HPB centres with experts in HPB surgery and found that most responders work in 'virtual' HPB centres without dedicated space, assigned beds, nor personal. We finally analysed our experience with the Swiss HPB centre, previously reported in this journal 15 years ago, disclosing that budget priorities set by the hospital administration may prevent the development of a fully integrated centre, for example through inconsistent assignment of the centre's beds to HBP patients or removal of dedicated intermediate care beds. We propose criteria for essential requirements for an HPB centre to deliver high-quality outcomes, with the concept of "centre of reference" limited to actual, as opposed to virtual, centres.
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