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

Authors :
Shah HP
Cohen O
Bourdillon AT
Burtness BA
Boffa DJ
Young M
Judson BL
Mehra S
Source :
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery [Otolaryngol Head Neck Surg] 2024 Aug; Vol. 171 (2), pp. 445-456. Date of Electronic Publication: 2024 Apr 12.
Publication Year :
2024

Abstract

Objective: We examined process-related quality metrics for oral squamous cell carcinoma (OSCC) depending on treating facility type across a health system and region.<br />Study Design: Retrospective in accordance with Strengthening the Reporting of Observational Studies in Epidemiology guidelines.<br />Setting: Single health system and region.<br />Methods: Patients 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.<br />Results: A 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).<br />Conclusion: Quality 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.<br /> (© 2024 American Academy of Otolaryngology–Head and Neck Surgery Foundation.)

Details

Language :
English
ISSN :
1097-6817
Volume :
171
Issue :
2
Database :
MEDLINE
Journal :
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery
Publication Type :
Academic Journal
Accession number :
38606669
Full Text :
https://doi.org/10.1002/ohn.755