Poster, Podium & Video Sessions
Presentation Authors: Keith Lawson*, Olli Saarela, Toronto, Canada, Robert Abouassaly, Simon Kim, Cleveland, OH, Rodney Breau, Ottawa, Canada, Antonio Finelli, Toronto, Canada
Introduction: Due to a paucity of real-world data benchmarking provider performance, it remains unclear whether all patients undergoing surgery for renal cell carcinoma (RCC) receive equivalent care. Consequently, the impact of quality variations on patient outcomes also remains elusive. Herein, we report the development and application of novel case-mix adjusted quality indicators (QIs) to benchmark nationwide hospital performance for RCC surgical care.
Methods: RCC patients undergoing surgery between 2004 and 2014 were identified from the National Cancer Database (NCDB). Hospital-level quality of care was assessed according to 2 disease-specific process QIs and 3 outcome QIs, selected based on Delphi consensus and literature review. Inter-hospital case-mix variation was adjusted for by multivariate modeling. For each hospital and given QI we calculated an observed to expected ratio, benchmarking hospital performance against the national average and identifying outlier hospitals providing sub-standard care. A composite measure of hospital quality, the renal cancer quality score (RC-QS), was subsequently derived and associations between RC-QS and surgical volume, academic affiliation and patient mortality were determined.
Results: Over 1100 hospitals were benchmarked for quality, with widespread hospital-level variation in performance observed across each QI. For a given QI, 9-35% of hospitals were identified as providing sub-standard care. Hospitals identified applying sub-standard care had lower referral volumes and were less academic as compared to higher quality hospitals (p < 0.001). Higher RC-QS was independently associated with lower 30-day, 90-day and overall mortality (OR [CI]: 0.95 [0.92-0.98], OR 0.94 [0.92-0.97], HR 0.97 [0.96-0.98] per unit increase, respectively).
Conclusions: Widespread variations in the quality of RCC surgery exist on a hospital-level. These variations can be captured by the RC-QS, a RCC specific composite measure of quality readily determined from the NCDB. Hospitals with good performance on the RC-QS are associated with improved patient outcomes, including mortality benefit. This data supports the use of the RC-QS as a national quality benchmarking tool for RCC surgery that provides audit level feedback to hospitals and policymakers for quality improvement.
Source Of Funding: Princess Margaret Hospital Foundation
University of Toronto
Keith A. Lawson MD, MSc, Surgeon Scientist Trainee, Division of Urology, Department of Surgery, University of Toronto.
BSc (Biological and Physical Sciences), Unversity of Alberta
MD/MSc (Cancer Biology), Leaders in Medicine Program, University of Calgary
Urology Residency, University of Toronto
PhD Student, Molecular Genetics, Surgeon Scientist Training Program, University of Toronto