Rhami Khorfan1, David T Cooke2, Robert A Meguid3, Leah Backhus4, Thomas K Varghese5, Farhood Farjah6, Karl Y Bilimoria7, David D Odell8. 1. Surgical Outcomes and Quality Improvement Center, Department of Surgery and Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, Ill. 2. Section of General Thoracic Surgery, University of California, Davis Medical Center, Davis, Calif. 3. Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, Colo. 4. Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University, Stanford, Calif. 5. Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah. 6. Division of Cardiothoracic Surgery, Department of Surgery, University of Washington, Seattle, Wash. 7. Northwestern Institute for Comparative Effectiveness Research in Oncology, Northwestern University Feinberg School of Medicine, Chicago, Ill. 8. Surgical Outcomes and Quality Improvement Center, Department of Surgery and Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, Ill; Northwestern Institute for Comparative Effectiveness Research in Oncology, Northwestern University Feinberg School of Medicine, Chicago, Ill. Electronic address: dodell@nm.org.
Abstract
OBJECTIVE: Although previous studies have identified variation in quality lung cancer care, existing quality metrics may not fully capture the complexity of cancer care. The Thoracic Surgery Outcomes Research Network recently developed quality measures to address this. We evaluated baseline adherence to these measures and identified factors associated with adherence. METHODS: Patients with pathologic stage I and II non-small cell lung cancer from 2010 to 2015 were identified in the National Cancer Database. Patient-level and hospital-level adherence to 7 quality measures was calculated. Goal hospital adherence threshold was 85%. Factors influencing adherence were identified using multilevel logistic regression. RESULTS: We identified 253,182 patients from 1324 hospitals. Lymph node sampling was performed in 91% of patients nationally, but only 76% of hospitals met the 85% adherence mark. Similarly, 89% of T1b (seventh edition staging) tumors had anatomic resection, with 69% hospital-level adherence. Sixty-nine percent of pathologic stage II patients were recommended chemotherapy, with only 23% hospitals adherent. Eighty-three percent of patients had biopsy before primary radiation, with 64% hospitals adherent. Higher volume and academic institutions were associated with nonadherence to adjuvant chemotherapy and radiation therapy measures. Conversely, lower volume and nonacademic institutions were associated with inadequate nodal sampling and nonanatomic resection. CONCLUSIONS: Significant gaps continue to exist in the delivery of quality care to patients with early-stage lung cancer. High-volume academic hospitals had higher adherence for surgical care measures, but lower rates for coordination of care measures. This requires further investigation, but suggests targets for quality improvement may vary by institution type.
OBJECTIVE: Although previous studies have identified variation in quality lung cancer care, existing quality metrics may not fully capture the complexity of cancer care. The Thoracic Surgery Outcomes Research Network recently developed quality measures to address this. We evaluated baseline adherence to these measures and identified factors associated with adherence. METHODS: Patients with pathologic stage I and II non-small cell lung cancer from 2010 to 2015 were identified in the National Cancer Database. Patient-level and hospital-level adherence to 7 quality measures was calculated. Goal hospital adherence threshold was 85%. Factors influencing adherence were identified using multilevel logistic regression. RESULTS: We identified 253,182 patients from 1324 hospitals. Lymph node sampling was performed in 91% of patients nationally, but only 76% of hospitals met the 85% adherence mark. Similarly, 89% of T1b (seventh edition staging) tumors had anatomic resection, with 69% hospital-level adherence. Sixty-nine percent of pathologic stage II patients were recommended chemotherapy, with only 23% hospitals adherent. Eighty-three percent of patients had biopsy before primary radiation, with 64% hospitals adherent. Higher volume and academic institutions were associated with nonadherence to adjuvant chemotherapy and radiation therapy measures. Conversely, lower volume and nonacademic institutions were associated with inadequate nodal sampling and nonanatomic resection. CONCLUSIONS: Significant gaps continue to exist in the delivery of quality care to patients with early-stage lung cancer. High-volume academic hospitals had higher adherence for surgical care measures, but lower rates for coordination of care measures. This requires further investigation, but suggests targets for quality improvement may vary by institution type.
Authors: Alex G Little; Valerie W Rusch; James A Bonner; Laurie E Gaspar; Mark R Green; W Richard Webb; Andrew K Stewart Journal: Ann Thorac Surg Date: 2005-12 Impact factor: 4.330
Authors: David D Odell; Joseph Feinglass; Kathryn Engelhardt; Steven Papastefan; Shari L Meyerson; Ankit Bharat; Malcolm M DeCamp; Karl Y Bilimoria Journal: J Thorac Cardiovasc Surg Date: 2018-11-13 Impact factor: 5.209
Authors: Nicholas R Faris; Matthew P Smeltzer; Fujin Lu; Carrie L Fehnel; Nibedita Chakraborty; Cheryl L Houston-Harris; E Todd Robbins; Raymond S Signore; Laura M McHugh; Bradley A Wolf; Lynn Wiggins; Paul Levy; Vishal Sachdev; Raymond U Osarogiagbon Journal: Semin Thorac Cardiovasc Surg Date: 2016-10-14
Authors: Pamela Samson; Traves Crabtree; Stephen Broderick; Daniel Kreisel; A Sasha Krupnick; G Alexander Patterson; Bryan Meyers; Varun Puri Journal: Ann Thorac Surg Date: 2016-09-21 Impact factor: 4.330
Authors: Farhood Farjah; David R Flum; Scott D Ramsey; Patrick J Heagerty; Rebecca Gaston Symons; Douglas E Wood Journal: J Thorac Oncol Date: 2009-03 Impact factor: 15.609