TY - JOUR
T1 - Variation in performance of candidate surgical quality measures for muscle-invasive bladder cancer by hospital type
AU - Corcoran, Anthony T.
AU - Handorf, Elizabeth
AU - Canter, Daniel
AU - Tomaszewski, Jeffrey J.
AU - Bekelman, Justin E.
AU - Kim, Simon P.
AU - Uzzo, Robert G.
AU - Kutikov, Alexander
AU - Smaldone, Marc C.
N1 - Publisher Copyright:
© 2014 The Authors. BJU International © 2014 BJU International.
PY - 2015/2/1
Y1 - 2015/2/1
N2 - Objective: To test the association between hospital type and performance of candidate quality measures for treatment of muscle-invasive bladder cancer (MIBC) using a large national tumour registry. Proposed quality measures include receipt of neoadjuvant chemotherapy, timely treatment, adequate lymph node dissection, and continent urinary diversion. Patients and Methods: Using the National Cancer Database, patients with stage ≥II urothelial carcinoma treated with radical cystectomy (RC) from 2003 to 2010 were identified. Hospitals were grouped by type and annual RC volume: community, comprehensive low volume (CLV), comprehensive high volume (CHV), academic low volume (ALV), and academic high volume (AHV) groups. Logistic regression models were used to test the association between hospital group and performance of quality measures, adjusting for year, demographic, and clinical/pathological characteristics; generalised estimating equations were fitted to the models to adjust for clustering at the hospital level. Results: In all, 23 279 patients underwent RC at community (12.4%), comprehensive (CLV 38%, CHV 5%), and academic (ALV 17%, AHV 28%) hospitals. While only 0.8% (175) of patients met all four quality criteria, 61% of patients treated at AHV hospitals met two or more quality metric indicators compared with ALV (45%), CHV (44%), CLV (38%), and community (37%) hospitals (P < 0.001). After adjustment, patients were more likely to receive two or more quality measures when treated at AHV (odds ratio [OR] 2.4, confidence interval [CI] 2.0-2.9), ALV (OR 1.3, CI 1.1-1.6), and CHV (OR 1.3, CI 1.03-1.7) hospitals compared with community hospitals. Conclusions: Patients undergoing RC at AHV hospitals were more likely to meet quality criteria. However, performance remains low across hospital types, highlighting the opportunity to improve quality of care for MIBC.
AB - Objective: To test the association between hospital type and performance of candidate quality measures for treatment of muscle-invasive bladder cancer (MIBC) using a large national tumour registry. Proposed quality measures include receipt of neoadjuvant chemotherapy, timely treatment, adequate lymph node dissection, and continent urinary diversion. Patients and Methods: Using the National Cancer Database, patients with stage ≥II urothelial carcinoma treated with radical cystectomy (RC) from 2003 to 2010 were identified. Hospitals were grouped by type and annual RC volume: community, comprehensive low volume (CLV), comprehensive high volume (CHV), academic low volume (ALV), and academic high volume (AHV) groups. Logistic regression models were used to test the association between hospital group and performance of quality measures, adjusting for year, demographic, and clinical/pathological characteristics; generalised estimating equations were fitted to the models to adjust for clustering at the hospital level. Results: In all, 23 279 patients underwent RC at community (12.4%), comprehensive (CLV 38%, CHV 5%), and academic (ALV 17%, AHV 28%) hospitals. While only 0.8% (175) of patients met all four quality criteria, 61% of patients treated at AHV hospitals met two or more quality metric indicators compared with ALV (45%), CHV (44%), CLV (38%), and community (37%) hospitals (P < 0.001). After adjustment, patients were more likely to receive two or more quality measures when treated at AHV (odds ratio [OR] 2.4, confidence interval [CI] 2.0-2.9), ALV (OR 1.3, CI 1.1-1.6), and CHV (OR 1.3, CI 1.03-1.7) hospitals compared with community hospitals. Conclusions: Patients undergoing RC at AHV hospitals were more likely to meet quality criteria. However, performance remains low across hospital types, highlighting the opportunity to improve quality of care for MIBC.
KW - Aged
KW - Aged, 80 and over
KW - Antineoplastic Agents/therapeutic use
KW - Cystectomy/standards
KW - Female
KW - Health Facility Size/statistics & numerical data
KW - Hospitals/standards
KW - Humans
KW - Lymph Node Excision/standards
KW - Male
KW - Middle Aged
KW - Muscle Neoplasms/mortality
KW - Neoadjuvant Therapy/standards
KW - Neoplasm Invasiveness
KW - Prognosis
KW - Quality Improvement
KW - Quality of Health Care/standards
KW - Registries
KW - United States/epidemiology
KW - Urinary Bladder Neoplasms/mortality
KW - Urinary Diversion/standards
UR - http://www.scopus.com/inward/record.url?scp=84921602541&partnerID=8YFLogxK
UR - https://www.webofscience.com/api/gateway?GWVersion=2&SrcApp=purepublist2023&SrcAuth=WosAPI&KeyUT=WOS:000348767100014&DestLinkType=FullRecord&DestApp=WOS
U2 - 10.1111/bju.12638
DO - 10.1111/bju.12638
M3 - Article
C2 - 24447637
SN - 1464-4096
VL - 115
SP - 230
EP - 237
JO - BJU International
JF - BJU International
IS - 2
ER -