Hospital‐level compliance with the commission on cancer’s quality of care measures and the association with patient survival

• Published in: Cancer medicine (Malden, MA) MA), 2021-06, Vol.10 (11), p.3533-3544
• Main Authors: Nussbaum, Daniel P., Rushing, Christel N., Sun, Zhifei, Yerokun, Babatunde A., Worni, Mathias, Saunders, Robert S., McClellan, Mark B., Niedzwiecki, Donna, Greenup, Rachel A., Blazer, Dan G.
• Format: Article
• Language: English
• Subjects: Accountability; Accreditation; Breast cancer; Breast Neoplasms - mortality; Breast Neoplasms - therapy; cancer; Cancer therapies; Carcinoma, Non-Small-Cell Lung - mortality; Carcinoma, Non-Small-Cell Lung - therapy; Chemotherapy; Clinical Cancer Research; Clinical outcomes; Colon cancer; Colonic Neoplasms - mortality; Colonic Neoplasms - therapy; Colorectal cancer; Databases, Factual; Female; Gastric cancer; Health care policy; hospitals; Hospitals - standards; Hospitals - statistics & numerical data; Humans; Kaplan-Meier Estimate; Lung cancer; Lung Neoplasms - mortality; Lung Neoplasms - therapy; Lymphatic system; Male; Mortality; Neoplasms - epidemiology; Neoplasms - mortality; Neoplasms - therapy; Patients; process measures; Proportional Hazards Models; Quality Improvement; Quality of care; Quality of Health Care; Radiation therapy; Rectal Neoplasms - mortality; Rectal Neoplasms - therapy; Stomach Neoplasms - mortality; Stomach Neoplasms - therapy; Surgery; Survival; United States - epidemiology
• ISSN: 2045-7634; 2045-7634
• DOI: 10.1002/cam4.3875

Background Quality measurement has become a priority for national healthcare reform, and valid measures are necessary to discriminate hospital performance and support value‐based healthcare delivery. The Commission on Cancer (CoC) is the largest cancer‐specific accreditor of hospital quality in the United States and has implemented Quality of Care Measures to evaluate cancer care delivery. However, none has been formally tested as a valid metric for assessing hospital performance based on actual patient outcomes. Methods Eligibility and compliance with the Quality of Care Measures are reported within the National Cancer Database, which also captures data for robust patient‐level risk adjustment. Hospital‐level compliance was calculated for the core measures, and the association with patient survival was tested using Cox regression. Results Seven hundred sixty‐eight thousand nine hundred sixty‐nine unique cancer cases were included from 1323 facilities. Increasing hospital‐level compliance was associated with improved survival for only two measures, including a 35% reduced risk of mortality for the gastric cancer measure G15RLN (HR 0.65, 95% CI 0.58–0.72) and a 19% reduced risk of mortality for the colon cancer measure 12RLN (HR 0.81, 95% CI 0.77–0.85). For the lung cancer measure LNoSurg, increasing compliance was paradoxically associated with an increased risk of mortality (HR 1.14, 95% CI 1.08–1.20). For the remaining measures, hospital‐level compliance demonstrated no consistent association with patient survival. Conclusion Hospital‐level compliance with the CoC’s Quality of Care Measures is not uniformly aligned with patient survival. In their current form, these measures do not reliably discriminate hospital performance and are limited as a tool for value‐based healthcare delivery. The Commission on Cancer is the largest cancer‐specific accreditor of hospital quality in the United States and has implemented Quality of Care Measures to evaluate quality cancer care delivery. This study represents the first comprehensive evaluation of the Quality of Care Measures as valid metrics for assessing hospital performance based on actual patient outcomes.