New Approach to Measuring and Improving Surgical Cancer Quality

Our objective is to develop a novel, comprehensive system to measure and improve hospital cancer surgery quality and outcomes. Hospitals will report detailed data, the data will be analyzed, and hospitals will receive a performance report card. Currently, no program or initiative specifically measures hospital surgical quality for cancer care, yet overwhelming evidence indicates that wide variation exists in the quality of cancer surgery and outcomes in the U.S. Nevertheless, hospitals have no idea how they perform compared to other hospitals for cancer surgery. Moreover, post-operative patient-reported outcomes have never been used to compare providers, and these patient-centered outcomes have been generally underappreciated in surgery despite their considerable importance to patients. Measuring hospital quality based on cancer surgery outcomes is challenging, and it requires high-quality data and reliable and accurate risk-adjustment methodology that accounts for patient (e.g., comorbidities), tumor (e.g., cancer stage, complexity of the operation), and preoperative cancer treatments (e.g., neoadjuvant therapy). The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) is the nation’s premier quality assessment and measurement program in surgery. ACS NSQIP provides each of the over 400 participating hospitals with confidential, risk-adjusted benchmarked reports for 24 surgical outcomes. ACS NSQIP offers an ideal platform for the development of a surgical oncology hospital quality measurement system. Finally, in addition to traditional outcome measures (e.g., mortality, morbidity), an underappreciated, yet equally important, measure of cancer surgical quality includes patient reported outcomes (PROs), (e.g., pain, physical function). Using the ACS NSQIP platform and the robust cancer-specific dataset developed for this project, we will be poised to develop a system that additionally measures hospital quality based on PROs. This pilot would represent the first of its kind in surgery. Given these gaps in the quality assessment of cancer surgery, our specific aims are: Aim 1: To identify cancer-specific risk-adjustment variables important for the assessment of short-term outcomes following cancer surgery Aim 2: To develop cancer-specific risk-adjustment models for postoperative outcomes and determine whether hospital cancer quality rankings differ with the inclusion of cancer-specific variables. Aim 3: To assess hospital quality rankings based on patient-reported outcomes.