Failure to administer recommended chemotherapy: acceptable variation or cancer care quality blind spot?

Author:

Ellis Ryan JORCID,Schlick Cary Jo R,Feinglass Joe,Mulcahy Mary F,Benson Al B,Kircher Sheetal M,Yang Tony D,Odell David D,Bilimoria Karl,Merkow Ryan P

Abstract

BackgroundChemotherapy quality measures consider hospitals compliant when chemotherapy is recommended, even if it is not received. This may mask shortcomings in cancer care delivery. Objectives of this study were to (1) identify patient factors associated with failure to receive recommended chemotherapy without a documented contraindication and (2) assess hospital variation in failure to administer recommended chemotherapy.MethodsPatients from 2005 to 2015 with breast, colon and lung cancers who failed to receive recommended chemotherapy were identified using the National Cancer Database. Hospital-level rates of failure to administer recommended chemotherapy were calculated, and patient and hospital factors associated with failure to receive recommended chemotherapy were identified by multivariable logistic regression.ResultsA total of 183 148 patients at 1281 hospitals were analysed. Overall, 3.5% of patients with breast, 6.6% with colon and 10.7% with lung cancers failed to receive recommended chemotherapy. Patients were less likely to receive recommended chemotherapy in all cancers if uninsured or on Medicaid (p<0.05), as were non-Hispanic black patients with both breast and colon cancer (p<0.001). Significant hospital variation was observed, with hospital-level rates of failure to administer recommended chemotherapy as high as 21.8% in breast, 40.2% in colon and 40.0% in lung cancers.Conclusions and relevanceThough overall rates are low, failure to receive recommended chemotherapy is associated with sociodemographic factors. Hospital variation in failure to administer recommended chemotherapy is masked by current quality measure definitions and may define a significant and unmeasured difference in hospital quality.

Funder

Center for Strategic Scientific Initiatives, National Cancer Institute

American Cancer Society

National Heart, Lung, and Blood Institute

Agency for Healthcare Research and Quality

Publisher

BMJ

Subject

Health Policy

Reference28 articles.

1. Cancer statistics, 2018

2. Clinical practice guidelines in breast cancer;Kumar Tyagi;Curr Oncol,2018

3. Systemic Management of Colorectal Cancer

4. A review of guidelines for lung cancer;Bironzo;J Thorac Dis,2018

5. CoC Quality of Care Measures . Standard 4.4 and 4.5 expected performance rates, 2018 surveys, 2018. Available: https://www.facs.org/quality-programs/cancer/ncdb/qualitymeasures [Accessed 21 Dec 2018].

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3