(ChemotherapyAdvisor) – Major challenges exist for hospitals with respect to publicly reported cancer metrics, according to a presentation at the 66th Annual Society of Surgical Oncology (SSO) Cancer Symposium, held in National Harbor, MD.
Increasingly, patients will turn to such metrics to select a hospital, which are required to be made public under the Patient Protection and Affordable Care Act. For example, a patient with resectable pancreatic cancer might seek data on local hospitals to help guide a choice. The challenge is how best to interpret findings that suggest Hospital A has “better than expected” outcomes in some areas and “worse than expected” outcomes in other areas, while Hospital B has the same findings—only in reverse.
Ryan P. Merkow, MD, of the Surgical Outcomes and Quality Improvement Center and the Northwestern Institute for Comparative Effectiveness Research in Oncology, Northwestern University, Chicago, IL, and colleagues compared processes of care, patient experience, efficacy (cost per patient), and several outcome measures for National Cancer Institute (NCI) Hospitals, hospitals accredited by the Commission on Cancer, and other hospitals using merged data from Medicare’s Hospital Compare and the American Hospital Association.
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The Surgical Care Improvement Project (SCIP) measures for processes of care including antibiotic timing and VTE prophylaxis. Patient experience reviewed overall satisfaction, whether the hospital would be recommended to others, and pain management. Outcomes reviewed patient safety indicators such as death, blood clot, dehiscence, and serious complications; hospital-acquired conditions such as bloodstream infection, urinary catheter infections, and colon surgical site infections; and hospital-acquired infections.
They found that NCI and Commission on Cancer-accredited hospitals outperformed “other” hospitals on antibiotic use, venous thromboembolism prophylaxis, and beta-blocker use; NCI hospitals had the highest overall satisfaction, hospital recommendations, and cost per patient; and Commission on Cancer-accredited hospitals had the highest rating for pain control (all P<0.05).
However, both NCI and Commission on Cancer-accredited hospitals had worse complications and infections than “other” hospitals, including death after serious mortality, blood clots, and serious complications (all P<0.05).
“Hospital characteristic varied widely by accreditation status,” Dr. Merkow said. “Accreditation status resulted in mixed findings: better for process, patient experiences, and cost, and worse for outcomes.” Potential explanations include that “accreditation is associated with worse outcomes and better process of care,” or that the data reflect imperfect risk adjustment, flawed measure specification, and/or bias.
These results underscore the need for more cancer-specific measures to help guide patients to high-quality hospitals and for “more engagement in cancer measure development and proposals for public reporting,” Dr. Merkow concluded.
The abstract (#56) for this presentation is available at the 66th Annual SSO Cancer Symposium’s website.
