Identifying Opportunities to Deliver High‐Quality Cancer Care Across a Health System: A Clinical Responsibility

Author:

Shah Hemali P.12ORCID,Cohen Oded234,Bourdillon Alexandra T.25,Burtness Barbara A.36,Boffa Daniel J.37,Young Melissa8,Judson Benjamin L.23,Mehra Saral23ORCID

Affiliation:

1. Department of Otolaryngology–Head and Neck Surgery MedStar Georgetown University Hospital Washington District of Columbia USA

2. Division of Otolaryngology–Head and Neck Surgery Yale Department of Surgery New Haven Connecticut USA

3. Yale Cancer Center New Haven Connecticut USA

4. Department of Otolaryngology–Head and Neck Surgery Ben Gurion University of the Negev Samson Assuta Ashdod University Hospital Ashdod Israel

5. Department of Otolaryngology–Head and Neck Surgery University of California‐San Francisco School of Medicine San Francisco California USA

6. Division of Medical Oncology, Department of Internal Medicine Yale School of Medicine New Haven Connecticut USA

7. Section of Thoracic Surgery, Department of Surgery Yale School of Medicine New Haven Connecticut USA

8. Department of Therapeutic Radiology Yale School of Medicine New Haven Connecticut USA

Abstract

AbstractObjectiveWe examined process‐related quality metrics for oral squamous cell carcinoma (OSCC) depending on treating facility type across a health system and region.Study DesignRetrospective in accordance with Strengthening the Reporting of Observational Studies in Epidemiology guidelines.SettingSingle health system and region.MethodsPatients with OSCC diagnosed between 2012 and 2018 were identified from tumor registries of 6 hospitals (1 academic and 5 community) within a single health system. Patients were categorized into 3 care groups: (1) solely at the academic center, (2) solely at community facilities, and (3) combined care at academic and community facilities. Primary outcome measures were process‐related quality metrics: positive surgical margin rate, lymph node yield (LNY), adjuvant treatment initiation ≤6 weeks, National Comprehensive Cancer Network (NCCN)‐guideline adherence.ResultsA total of 499 patients were included: 307 (61.5%) patients in the academic‐only group, 101 (20.2%) in the community‐only group, and 91 (18.2%) in the combined group. Surgery at community hospitals was associated with increased odds of positive surgical margins (11.9% vs 2.5%, odds ratio [OR]: 47.73, 95% confidence interval [CI]: 11.2‐275.86, P < .001) and lower odds of LNY ≥ 18 (52.8% vs 85.9%, OR: 0.15, 95% CI: 0.07‐0.33, P < .001) relative to the academic center. Compared with the academic‐only group, odds of adjuvant treatment initiation ≤6 weeks were lower for the combined group (OR: 0.30, 95% CI: 0.13‐0.64, P = .002) and odds of NCCN guideline‐adherent treatment were lower in the community only group (OR: 0.35, 95% CI: 0.18‐0.70, P = .003).ConclusionQuality of oral cancer care across the health system and region is comparable to or better‐than national standards, indicating good baseline quality of care. Differences by facility type and fragmentation of care present an opportunity for bringing best in‐class cancer care across an entire region.

Publisher

Wiley

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