"Systematic review of the evidence relating process of care to outcome and cost in specialist and non-specialist hospital settings"

The Department of Health has accepted the recommendations of its Expert Advisory Group on Cancer that hospital treatment should only occur in the 'specialist' settings of Cancer Units and Cancer Centres. This policy was promoted by professional associations and is supported by patients' associations and the wider public, as a means by which variations in the quality of care might be minimised. It is assumed that "universalising the best" will ensure optimal outcomes for cancer patients. There is good, if circumstantial, evidence that this is so for the rare, but potentially curable malignancies, but comparable data for the common adult cancers is limited.
This study will systematically identify and critically evaluate the relevant literature relating to:-

• Organisational and professional specialisation.
• Process of care (concentrating on proxy measures for quality of care - trial entry, use of treatment protocols, compliance with concensus conference guidelines) to
• Outcome - psychosocial assessment and survival and
• Use of resources.

A preliminary literature search suggests that adequate information satisfactorily to address the relationship between these issues may be very limited. The study will therefore also identify areas for future primary research studies.

Further information may be obtained from:

Dr Maggie Harding
Specialist Registrar in Public Health Medicine
c/o Health Care Evaluation Unit
Department of Public Health Services
St. George's Hospital Medical School
Cranmer Terrace
Tooting
London   SW17 0RE
UK