Jason B Liu1,2, Andrea L Pusic3, Bruce L Hall4,5,6,7, Robert E Glasgow8, Clifford Y Ko4,9, Larissa K Temple10. 1. American College of Surgeons, 633 N. St. Clair St., 22nd floor, Chicago, IL, 60611, USA. jliu@facs.org. 2. Department of Surgery, University of Chicago Medicine, Chicago, IL, USA. jliu@facs.org. 3. Division of Plastic Surgery, Patient-Reported Outcomes, Value, and Experience (PROVE) Center, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA. 4. American College of Surgeons, 633 N. St. Clair St., 22nd floor, Chicago, IL, 60611, USA. 5. Department of Surgery, Washington University in St. Louis, Saint Louis Veterans Affairs Medical Center, St. Louis, MO, USA. 6. Center for Health Policy and the Olin Business School, Washington University in St. Louis, St. Louis, MO, USA. 7. BJC Healthcare, St. Louis, MO, USA. 8. Department of Surgery, University of Utah Health, Salt Lake City, UT, USA. 9. Department of Surgery, University of California Los Angeles David Geffen School of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA. 10. Division of Colorectal Surgery, University of Rochester Medical Center, Rochester, NY, USA.
Abstract
BACKGROUND: Assessments of surgical quality should consider both surgeon and patient perspectives simultaneously. Focusing on patients undergoing major gastrointestinal cancer surgery, we sought to characterize hospitals, and their patients, on both these axes of quality. METHODS: Using the American College of Surgeons' National Surgical Quality Improvement Program registry, hospitals were profiled on a risk-adjusted composite measure of death or serious morbidity (DSM) generated from patients who underwent colectomy, esophagectomy, hepatectomy, pancreatectomy, or proctectomy for cancer between January 1, 2015 and December 31, 2016. These hospitals were also profiled using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Highest-performing hospitals on both quality axes, and their respective patients, were compared to the lowest-performing hospitals. RESULTS: Overall, 60,526 patients underwent their cancer operation at 530 hospitals. There were 38 highest- and 48 lowest-performing hospitals. The correlation between quality axes was poor (ρ = 0.10). Compared to the lowest-performing hospitals, the highest-performing hospitals were more often NCI-designated cancer centers (29.0% vs. 4.2%, p = 0.002) and cared for a lower proportion of Medicaid patients (0.14 vs. 0.23, p < 0.001). Patients who had their operations at the lowest- versus highest-performing hospitals were more often black (17.2% vs. 8.4%, p < 0.001), Hispanic (8.3% vs. 3.5%, p < 0.001), functionally dependent (3.8% vs. 0.9%, p < 0.001), and not admitted from home (4.4% vs. 2.4%, p < 0.001). CONCLUSIONS: Hospital performance varied when assessed by both risk-adjusted surgical outcomes and patient experiences. In this study, poor-performing hospitals appeared to be disproportionately serving disadvantaged and minority cancer patients.
BACKGROUND: Assessments of surgical quality should consider both surgeon and patient perspectives simultaneously. Focusing on patients undergoing major gastrointestinal cancer surgery, we sought to characterize hospitals, and their patients, on both these axes of quality. METHODS: Using the American College of Surgeons' National Surgical Quality Improvement Program registry, hospitals were profiled on a risk-adjusted composite measure of death or serious morbidity (DSM) generated from patients who underwent colectomy, esophagectomy, hepatectomy, pancreatectomy, or proctectomy for cancer between January 1, 2015 and December 31, 2016. These hospitals were also profiled using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Highest-performing hospitals on both quality axes, and their respective patients, were compared to the lowest-performing hospitals. RESULTS: Overall, 60,526 patients underwent their cancer operation at 530 hospitals. There were 38 highest- and 48 lowest-performing hospitals. The correlation between quality axes was poor (ρ = 0.10). Compared to the lowest-performing hospitals, the highest-performing hospitals were more often NCI-designated cancer centers (29.0% vs. 4.2%, p = 0.002) and cared for a lower proportion of Medicaid patients (0.14 vs. 0.23, p < 0.001). Patients who had their operations at the lowest- versus highest-performing hospitals were more often black (17.2% vs. 8.4%, p < 0.001), Hispanic (8.3% vs. 3.5%, p < 0.001), functionally dependent (3.8% vs. 0.9%, p < 0.001), and not admitted from home (4.4% vs. 2.4%, p < 0.001). CONCLUSIONS: Hospital performance varied when assessed by both risk-adjusted surgical outcomes and patient experiences. In this study, poor-performing hospitals appeared to be disproportionately serving disadvantaged and minority cancerpatients.
Entities:
Keywords:
Cancer surgery; NSQIP; Outcomes; Patient-reported experiences; Patient-reported outcomes; Quality
Authors: Mark E Cohen; Clifford Y Ko; Karl Y Bilimoria; Lynn Zhou; Kristopher Huffman; Xue Wang; Yaoming Liu; Kari Kraemer; Xiangju Meng; Ryan Merkow; Warren Chow; Brian Matel; Karen Richards; Amy J Hart; Justin B Dimick; Bruce L Hall Journal: J Am Coll Surg Date: 2013-04-28 Impact factor: 6.113
Authors: Linda H Aiken; Douglas M Sloane; Jeannie P Cimiotti; Sean P Clarke; Linda Flynn; Jean Ann Seago; Joanne Spetz; Herbert L Smith Journal: Health Serv Res Date: 2010-04-09 Impact factor: 3.402