Northwestern University Feinberg School of Medicine

Institute for Public Health and Medicine

New Approach to Measuring and Improving Surgical Cancer Quality

May 24, 2013

Background: Considerable hospital-to-hospital variation exists in the quality of cancer surgery in the U.S.  This has led to an increasing focus on quality measurement and improvement efforts. For surgery, oversight agencies and payers have focused on measurable short-term postoperative outcomes. Surgical quality improvement programs have been developed to provide performance reports to individual hospitals to help identify areas of suboptimal outcomes and trigger targeted quality improvement. The most prominent of these programs is the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) which provides reports of risk-adjusted short-term outcomes for broad categories of surgeries (e.g., general surgery, vascular surgery), and no cancer surgery-specific reports are provided to hospitals. No national initiative exists to evaluate hospital surgical quality and safety following cancer surgery. This is not surprising given that the measurement of quality for cancer surgery presents challenges, particularly with respect to development of reliable and accurate risk-adjustment models that account for differences in both patient factors (e.g., comorbidities) and disease factors (e.g., stage of disease, neoadjuvant therapy use). Moreover, some relevant post-operative patient-reported outcomes (PROs) best assessed by asking patients directly (e.g., pain, fatigue) may be useful to consider for benchmarking hospital cancer surgery outcomes, but no such initiative has been established in surgery.

Main Objective: To develop a novel, reliable system to measure and improve the quality of cancer surgery

Specific Aim 1. To identify cancer-specific risk-adjustment variables important for the assessment of short-term outcomes after cancer surgery

Hypothesis: Certain cancer-specific variables (e.g., M stage) will be important to improve the prediction of cancer surgery outcomes, while others will not be useful

Specific Aim 2. To determine whether hospital cancer surgery quality rankings differ with the inclusion of cancer-specific variables

Hypothesis: Certain cancer-specific variables will change cancer surgery hospital quality rankings and are therefore needed to improve the accuracy and robustness of performance report cards

Specific Aim 3. To compare hospital quality based on patient-reported outcomes (general satisfaction, pain and physical function) after cancer surgery using validated measurement tools

Hypothesis: Substantial hospital-to-hospital variation exists in PROs, and it is feasible to compare hospital quality based on PROs following cancer surgery

Center: Healthcare Studies

Funder: American Cancer Society (ACS)

Principal Investigator:
Karl Bilimoria