Risk-Adjusted Mortality Rates as a Quality Proxy Outperform Volume in Surgical Oncology—A New Perspective on Hospital Centralization Using National Population-Based Data

2022 ◽  
Author(s):  
Philip Baum ◽  
Jacopo Lenzi ◽  
Johannes Diers ◽  
Christoph Rust ◽  
Martin E. Eichhorn ◽  
...  
Keyword(s):  
High Volume ◽  
Surgical Oncology ◽  
Population Based ◽  
Travel Times ◽  
Oncologic Surgery ◽  
Surgical Quality ◽  
High Volume Hospital ◽  
Cancer Types ◽  
Validation Set ◽  
New Perspective

PURPOSE Despite a long-known association between annual hospital volume and outcome, little progress has been made in shifting high-risk surgery to safer hospitals. This study investigates whether the risk-standardized mortality rate (RSMR) could serve as a stronger proxy for surgical quality than volume. METHODS We included all patients who underwent complex oncologic surgeries in Germany between 2010 and 2018 for any of five major cancer types, splitting the data into training (2010-2015) and validation sets (2016-2018). For each surgical group, we calculated annual volume and RSMR quintiles in the training set and applied these thresholds to the validation set. We studied the overlap between the two systems, modeled a market exit of low-performing hospitals, and compared effectiveness and efficiency of volume- and RSMR-based rankings. We compared travel distance or time that would be required to reallocate patients to the nearest hospital with low-mortality ranking for the specific procedure. RESULTS Between 2016 and 2018, 158,079 patients were treated in 974 hospitals. At least 50% of high-volume hospitals were not ranked in the low-mortality group according to RSMR grouping. In an RSMR centralization model, an average of 32 patients undergoing complex oncologic surgery would need to relocate to a low-mortality hospital to save one life, whereas 47 would need to relocate to a high-volume hospital. Mean difference in travel times between the nearest hospital to the hospital that performed surgery ranged from 10 minutes for colorectal cancer to 24 minutes for pancreatic cancer. Centralization on the basis of RSMR compared with volume would ensure lower median travel times for all cancer types, and these times would be lower than those observed. CONCLUSION RSMR is a promising proxy for measuring surgical quality. It outperforms volume in effectiveness, efficiency, and hospital availability for patients.

scholarly journals Incidence, comorbidity and mortality in patients with necrotising soft-tissue infections, 2005–2018: a Danish nationwide register-based cohort study

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e041302
Author(s):  
Morten Hedetoft ◽  
Martin Bruun Madsen ◽  
Lærke Bruun Madsen ◽  
Ole Hyldegaard
Keyword(s):  
Soft Tissue ◽  
High Volume ◽  
Population Based ◽  
Treatment Modalities ◽  
Soft Tissue Infections ◽  
Registration System ◽  
Female Sex ◽  
High Volume Hospital ◽  
Comorbidity Index ◽  
Necrotising Soft Tissue Infections

ObjectiveTo assess the incidence, comorbidities, treatment modalities and mortality in patients with necrotising soft-tissue infections (NSTIs) in Denmark.DesignNationwide population-based registry study.SettingDenmark.ParticipantsDanish residents with NSTI between 1 January 2005 and 31 August 2018.Main outcome measureIncidence of disease per 100 000 person/year and all-cause mortality at day 90 obtained from Danish National Patient Registry and the Danish Civil Registration System.Results1527 patients with NSTI were identified, yielding an incidence of 1.99 per 100 000 person/year. All-cause 30-day, 90-day and 1-year mortality were 19.4% (95% CI 17.4% to 21.5%), 25.2% (95% CI 23.1% to 27.5%) and 30.4% (95% CI 28.0% to 32.8%), respectively. Amputation occurred in 7% of the individuals. Diabetes was the most predominant comorbidity affecting 43% of the cohort, while 26% had no comorbidities. Higher age, female sex and increasing comorbidity index were found to be independent risk factors of mortality. Admission to high-volume hospitals was associated with improved survival (OR 0.59, 95% CI 0.45 to 0.77). Thirty-six per cent received hyperbaric oxygen therapy (HBOT) as an adjunctive therapy. No change in overall mortality was found over the studied time period.ConclusionThe present study found that in Denmark, the incidence of NSTI increased; mortality rates remained high and largely unaltered. Diabetes was the most common comorbidity, while higher age, female sex and increasing comorbidity index were associated to increased mortality. Survival was improved in those admitted to hospitals with more expertise in treating NSTI. In high-volume hospital, HBOT was associated with decreased odds for mortality.

scholarly journals Association between Moving to a High-Volume Hospital in the Capital Area and the Mortality among Patients with Cancer: A Large Population-Based Cohort Study

2021 ◽  
Vol 18 (7) ◽  
pp. 3812
Author(s):  
Jung-kyu Choi ◽  
Se-Hyung Kim ◽  
Myung-Bae Park
Keyword(s):  
Low Income ◽  
Large Population ◽  
High Volume ◽  
Healthcare Services ◽  
Population Based ◽  
Patients With Cancer ◽  
Final Sample ◽  
High Volume Hospital ◽  
Study Population ◽  
Low Income Families

This study aimed to identify the association between moving to a high-volume hospital and the mortality of patients with cancer living in the district. The study population comprised participants diagnosed with cancer within the past nine years (2004–2012). The final sample included 8197 patients with cancer, 3939 were males (48.1%), and 4258 were females (51.9%). A Cox proportional hazard model was used to estimate the hazard ratio (HR) for death. Confounding variables including sex, age, type of social security, income level, disability, and utilization volume were incorporated into the model. Among patients with cancer living in the district, 2874 (35.1%) used healthcare services in Seoul. About 10% (n = 834) of patients died during the follow-up period. The HR for death in females (HR: 0.68, 95% CI: 0.58–0.81) was lower than that in males. Additionally, the HR for the death of patients using healthcare services in Seoul (HR: 1.30, 95% CI: 1.11–1.53) was higher than those patients who did not use healthcare services in Seoul. Among patients utilizing services in the province, wealthier patients’ survival probability was significantly higher than that of others. The cause of income differences should be identified, and accessibility to medical use of low-income families should be enhanced to prevent mortality of patients from cancer disparities.

scholarly journals Quality Assurance and Continuing Education: A Cyclic Approach for Maintaining High Quality Data in a High Volume Cancer Registry

2020 ◽  
Vol 27 (3) ◽  
pp. 107327482094679
Author(s):  
Vicki Hawhee ◽  
Jennie Jones ◽  
Sandy Stewart ◽  
Kristin Lucia ◽  
Dana E. Rollison
Keyword(s):  
Quality Assurance ◽  
Continuing Education ◽  
Cancer Registry ◽  
High Volume ◽  
Population Based ◽  
Cancer Surveillance ◽  
Quality Data ◽  
High Quality ◽  
High Quality Data ◽  
High Volume Hospital

Quality Assurance and Education are 2 areas of the Cancer Registry that go hand in hand. High-quality data can only be maintained through routine surveillance of data quality coupled with tailored continuing education of certified tumor registrars (CTRs). However, the magnitude of information a CTR is required to know, the rapid frequency with which standards change, and growing demands on the time of the CTRs can be roadblocks to maintaining quality in the Cancer Registry. Here we describe a robust approach to quality assurance in a high-volume hospital-based Cancer Registry, leveraging a repeated cycle of quality assessment and educational activities targeting identified opportunities for improvement. Establishing such an approach encourages the professional development of CTRs while simultaneously ensuring the highest quality data for use in population-based cancer surveillance, cancer research, and patient care.

Learning curve for hysterectomy in a high-volume-hospital after implementation of endoscopic procedure

2014 ◽  
Vol 74 (S 01) ◽  
Author(s):  
R Mavrova ◽  
JC Radosa ◽  
D Bardens ◽  
K Neis ◽  
S Wagenpfeil ◽  
...  
Keyword(s):  
Learning Curve ◽  
High Volume ◽  
Endoscopic Procedure ◽  
High Volume Hospital

scholarly journals Self-reported causes of cancer among 6881 survivors with 6 tumour types: results from the PROFILES registry

2021 ◽  
Author(s):  
Carla Vlooswijk ◽  
Olga Husson ◽  
Simone Oerlemans ◽  
Nicole Ezendam ◽  
Dounya Schoormans ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Multiple Myeloma ◽  
Cancer Survivors ◽  
Causal Attributions ◽  
Population Based ◽  
Comorbid Conditions ◽  
Prostate Cancer Survivors ◽  
Cancer Types ◽  
External Causes ◽  
Single Question

Abstract Objective Our aim was to describe and compare self-reported causal attributions (interpretations of what caused an illness) among cancer survivors and to assess which sociodemographic and clinical characteristics are associated with them. Methods Data from five population-based PROFILES registry samples (i.e. lymphoma (n = 993), multiple myeloma (n = 156), colorectal (n = 3989), thyroid (n = 306), endometrial (n = 741), prostate cancer (n = 696)) were used. Causal attributions were assessed with a single question. Results The five most often reported causal attributions combined were unknown (21%), lifestyle (19%), biological (16%), other (14%), and stress (12%). Lymphoma (49%), multiple myeloma (64%), thyroid (55%), and prostate (64%) cancer patients mentioned fixed causes far more often than modifiable or modifiable/fixed. Colorectal (33%, 34%, and 33%) and endometrial (38%, 32%, and 30%) cancer survivors mentioned causes that were fixed, modifiable, or both almost equally often. Colorectal, endometrial, and prostate cancer survivors reported internal causes most often, whereas multiple myeloma survivors more often reported external causes, while lymphoma and thyroid cancer survivors had almost similar rates of internal and external causes. Females, those older, those treated with hormonal therapy, and those diagnosed with prostate cancer were less likely to identify modifiable causes while those diagnosed with stage 2, singles, with ≥2 comorbid conditions, and those with endometrial cancer were more likely to identify modifiable causes. Conclusion In conclusion, this study showed that patients report both internal and external causes of their illness and both fixed and modifiable causes. This differsbetween the various cancer types. Implications for Cancer Survivors Although the exact cause of cancer in individual patients is often unknown, having a well-informed perception of the modifiable causes of one’s cancer is valuable since it can possibly help survivors with making behavioural adjustments in cases where this is necessary or possible.

scholarly journals Colorectal Cancer Surgery Quality in Manitoba: A Population-Based Descriptive Analysis

2021 ◽  
Vol 28 (3) ◽  
pp. 2239-2247
Author(s):  
Iresha Ratnayake ◽  
Jason Park ◽  
Natalie Biswanger ◽  
Allison Feely ◽  
Grace Musto ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Colon Cancer ◽  
Laparoscopic Surgery ◽  
Descriptive Analysis ◽  
Population Based ◽  
Cancer Surgery ◽  
Formal Structure ◽  
Colorectal Cancer Surgery ◽  
Surgical Quality ◽  
Clinical Variation

Unwarranted clinical variation in healthcare impacts access, productivity, performance, and outcomes. A strategy proposed for reducing unwarranted clinical variation is to ensure that population-based data describing the current state of health care services are available to clinicians and healthcare decision-makers. The objective of this study was to measure variation in colorectal cancer surgical treatment patterns and surgical quality in Manitoba and identify areas for improvement. This descriptive study included individuals aged 20 years or older who were diagnosed with invasive cancer (adenocarcinoma) of the colon or rectum between 1 January 2010 and 31 December 2014. Laparoscopic surgery was higher in colon cancer (24.1%) compared to rectal cancer (13.6%). For colon cancer, the percentage of laparoscopic surgery ranged from 12.9% to 29.2%, with significant differences by regional health authority (RHA) of surgery. In 86.1% of colon cancers, ≥12 lymph nodes were removed. In Manitoba, the negative circumferential resection margin for rectal cancers was 96.9%, and ranged from 96.0% to 100.0% between RHAs. The median time between first colonoscopy and resection was 40 days for individuals with colon cancer. This study showed that high-quality colorectal cancer surgery is being conducted in Manitoba along with some variation and gaps in quality. As a result of this work, a formal structure for ongoing measuring and reporting surgical quality has been established in Manitoba. Quality improvement initiatives have been implemented based on these findings and periodic assessments of colorectal cancer surgery quality will continue.

What Constitutes a “High-Volume” Hospital for Pancreatic Resection?

2008 ◽  
Vol 206 (4) ◽  
pp. 622.e1-622.e9 ◽  
Author(s):  
Robert A. Meguid ◽  
Nita Ahuja ◽  
David C. Chang
Keyword(s):  
Pancreatic Resection ◽  
High Volume ◽  
High Volume Hospital

Relationship between hospital surgical volume, lobectomy rates, and adverse perioperative events at US epilepsy centers

2013 ◽  
Vol 118 (1) ◽  
pp. 169-174 ◽  
Author(s):  
Dario J. Englot ◽  
David Ouyang ◽  
Doris D. Wang ◽  
John D. Rolston ◽  
Paul A. Garcia ◽  
...  
Keyword(s):  
Relative Risk ◽  
Epilepsy Surgery ◽  
Intractable Epilepsy ◽  
High Volume ◽  
Population Based ◽  
Treatment Center ◽  
Surgical Volume ◽  
Related Factors ◽  
Perioperative Morbidity ◽  
Low Volume

Object Epilepsy surgery remains significantly underutilized. The authors recently reported that the number of lobectomies for localized intractable epilepsy in the US has not changed despite the implementation of clear evidence-based guidelines 10 years ago supporting early referral for surgery. To better understand why epilepsy surgery continues to be underused, the authors' objective was to carefully examine hospital-related factors related to the following: 1) where patients are being admitted for the evaluation of epilepsy, 2) rates of utilization for surgery across hospitals, and 3) perioperative morbidity between hospitals with low versus high volumes of epilepsy surgery. Methods The authors performed a population-based cohort study of US hospitals between 1990 and 2008 using the Nationwide Inpatient Sample (NIS), stratifying epilepsy surgery rates and trends as well as perioperative morbidity rates by hospital surgical volume. Results The number of lobectomies for epilepsy performed at high-volume centers (> 15 lobectomies/year) significantly decreased between 1990 and 2008 (F = 20.4, p < 0.001), while significantly more procedures were performed at middle-volume hospitals (5–15 lobectomies/year) over time (F = 16.1, p < 0.001). No time trend was observed for hospitals performing fewer than 5 procedures per year. However, patients admitted to high-volume centers were significantly more likely to receive lobectomy than those at low-volume hospitals (relative risk 1.05, 95% CI 1.03–1.08, p < 0.001). Also, the incidence of perioperative adverse events was significantly higher at low-volume hospitals (12.9%) than at high-volume centers (6.1%) (relative risk 1.08, 95% CI 1.03–1.07, p < 0.001). Conclusions Hospital volume is an important predictor of epilepsy surgery utilization and perioperative morbidity. Patients with medically refractory epilepsy should be referred to a comprehensive epilepsy treatment center for surgical evaluation by an experienced clinical team.

Primary Uterine Cancer in Maryland: Impact of Distance on Access to Surgical Care at High-Volume Hospitals

2013 ◽  
Vol 23 (7) ◽  
pp. 1244-1251 ◽  
Author(s):  
Camille C. Gunderson ◽  
Ana I. Tergas ◽  
Aimee C. Fleury ◽  
Teresa P. Diaz-Montes ◽  
Robert L. Giuntoli
Keyword(s):  
Confidence Interval ◽  
Odds Ratio ◽  
Uterine Cancer ◽  
Multivariable Analysis ◽  
Community Setting ◽  
Surgical Care ◽  
High Volume ◽  
High Volume Hospital ◽  
To Receive ◽  
Zip Code

ObjectiveTo evaluate the influence of distance on access to high-volume surgical treatment for patients with uterine cancer in Maryland.MethodsThe Maryland Health Services Cost Review Commission database was retrospectively searched to identify primary uterine cancer surgical cases from 1994 to 2010. Race, type of insurance, year of surgery, community setting, and both surgeon and hospital volume were collected. Geographical coordinates of hospital and patient’s zip code were used to calculate primary independent outcomes of distance traveled and distance from nearest high-volume hospital (HVH). Logistic regression was used to calculate odds ratios and confidence intervals.ResultsFrom 1994 to 2010, 8529 women underwent primary surgical management of uterine cancer in Maryland. Multivariable analysis demonstrated white race, rural residence, surgery by a high-volume surgeon and surgery from 2003 to 2010 to be associated with both travel 50 miles or more to the treating hospital and residence 50 miles or more from the nearest HVH (allP< 0.05). Patients who travel 50 miles or more to the treating hospital are more likely to have surgery at a HVH (odds ratio, 6.03; 95% confidence interval, 4.67–7.79) In contrast, patients, who reside ≥50 miles from a HVH, are less likely to have their surgery at an HVH. (odds ratio, 0.37; 95% confidence interval, 0.32–0.42).ConclusionIn Maryland, 50 miles or more from residence to the nearest HVH is a barrier to high-volume care. However, patients who travel 50 miles or more seem to do so to receive care by a high-volume surgeon at an HVH. In Maryland, Nonwhites are more likely to live closer to an HVH and more likely to use these services.

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