Failure to administer recommended chemotherapy

Acceptable variation or cancer care quality blind spot?

Ryan J. Ellis, Cary Jo R. Schlick, Joseph M Feinglass, Mary Frances Mulcahy, Al B. Benson, Sheetal Mehta Kircher, Tony D. Yang, David Duston Odell, Karl Y Bilimoria, Ryan Patrick Merkow*

*Corresponding author for this work

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Chemotherapy quality measures consider hospitals compliant when chemotherapy is recommended, even if it is not received. This may mask shortcomings in cancer care delivery. Objectives of this study were to (1) identify patient factors associated with failure to receive recommended chemotherapy without a documented contraindication and (2) assess hospital variation in failure to administer recommended chemotherapy. Methods: Patients from 2005 to 2015 with breast, colon and lung cancers who failed to receive recommended chemotherapy were identified using the National Cancer Database. Hospital-level rates of failure to administer recommended chemotherapy were calculated, and patient and hospital factors associated with failure to receive recommended chemotherapy were identified by multivariable logistic regression. Results: A total of 183 148 patients at 1281 hospitals were analysed. Overall, 3.5% of patients with breast, 6.6% with colon and 10.7% with lung cancers failed to receive recommended chemotherapy. Patients were less likely to receive recommended chemotherapy in all cancers if uninsured or on Medicaid (p<0.05), as were non-Hispanic black patients with both breast and colon cancer (p<0.001). Significant hospital variation was observed, with hospital-level rates of failure to administer recommended chemotherapy as high as 21.8% in breast, 40.2% in colon and 40.0% in lung cancers. Conclusions and relevance: Though overall rates are low, failure to receive recommended chemotherapy is associated with sociodemographic factors. Hospital variation in failure to administer recommended chemotherapy is masked by current quality measure definitions and may define a significant and unmeasured difference in hospital quality.

Original languageEnglish (US)
JournalBMJ Quality and Safety
DOIs
StatePublished - Jan 1 2019

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Quality of Health Care
Optic Disk
Drug Therapy
Neoplasms
Lung Neoplasms
Colonic Neoplasms
Colon
Breast
Breast Neoplasms
Medicaid
Masks
Logistic Models
Databases

Keywords

  • health services research
  • quality measurement
  • surgery

ASJC Scopus subject areas

  • Health Policy

Cite this

@article{fe3ed79f4c4646c0a54ee012bd8a5b83,
title = "Failure to administer recommended chemotherapy: Acceptable variation or cancer care quality blind spot?",
abstract = "Background: Chemotherapy quality measures consider hospitals compliant when chemotherapy is recommended, even if it is not received. This may mask shortcomings in cancer care delivery. Objectives of this study were to (1) identify patient factors associated with failure to receive recommended chemotherapy without a documented contraindication and (2) assess hospital variation in failure to administer recommended chemotherapy. Methods: Patients from 2005 to 2015 with breast, colon and lung cancers who failed to receive recommended chemotherapy were identified using the National Cancer Database. Hospital-level rates of failure to administer recommended chemotherapy were calculated, and patient and hospital factors associated with failure to receive recommended chemotherapy were identified by multivariable logistic regression. Results: A total of 183 148 patients at 1281 hospitals were analysed. Overall, 3.5{\%} of patients with breast, 6.6{\%} with colon and 10.7{\%} with lung cancers failed to receive recommended chemotherapy. Patients were less likely to receive recommended chemotherapy in all cancers if uninsured or on Medicaid (p<0.05), as were non-Hispanic black patients with both breast and colon cancer (p<0.001). Significant hospital variation was observed, with hospital-level rates of failure to administer recommended chemotherapy as high as 21.8{\%} in breast, 40.2{\%} in colon and 40.0{\%} in lung cancers. Conclusions and relevance: Though overall rates are low, failure to receive recommended chemotherapy is associated with sociodemographic factors. Hospital variation in failure to administer recommended chemotherapy is masked by current quality measure definitions and may define a significant and unmeasured difference in hospital quality.",
keywords = "health services research, quality measurement, surgery",
author = "Ellis, {Ryan J.} and Schlick, {Cary Jo R.} and Feinglass, {Joseph M} and Mulcahy, {Mary Frances} and Benson, {Al B.} and Kircher, {Sheetal Mehta} and Yang, {Tony D.} and Odell, {David Duston} and Bilimoria, {Karl Y} and Merkow, {Ryan Patrick}",
year = "2019",
month = "1",
day = "1",
doi = "10.1136/bmjqs-2019-009742",
language = "English (US)",
journal = "BMJ Quality and Safety",
issn = "2044-5415",
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TY - JOUR

T1 - Failure to administer recommended chemotherapy

T2 - Acceptable variation or cancer care quality blind spot?

AU - Ellis, Ryan J.

AU - Schlick, Cary Jo R.

AU - Feinglass, Joseph M

AU - Mulcahy, Mary Frances

AU - Benson, Al B.

AU - Kircher, Sheetal Mehta

AU - Yang, Tony D.

AU - Odell, David Duston

AU - Bilimoria, Karl Y

AU - Merkow, Ryan Patrick

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Chemotherapy quality measures consider hospitals compliant when chemotherapy is recommended, even if it is not received. This may mask shortcomings in cancer care delivery. Objectives of this study were to (1) identify patient factors associated with failure to receive recommended chemotherapy without a documented contraindication and (2) assess hospital variation in failure to administer recommended chemotherapy. Methods: Patients from 2005 to 2015 with breast, colon and lung cancers who failed to receive recommended chemotherapy were identified using the National Cancer Database. Hospital-level rates of failure to administer recommended chemotherapy were calculated, and patient and hospital factors associated with failure to receive recommended chemotherapy were identified by multivariable logistic regression. Results: A total of 183 148 patients at 1281 hospitals were analysed. Overall, 3.5% of patients with breast, 6.6% with colon and 10.7% with lung cancers failed to receive recommended chemotherapy. Patients were less likely to receive recommended chemotherapy in all cancers if uninsured or on Medicaid (p<0.05), as were non-Hispanic black patients with both breast and colon cancer (p<0.001). Significant hospital variation was observed, with hospital-level rates of failure to administer recommended chemotherapy as high as 21.8% in breast, 40.2% in colon and 40.0% in lung cancers. Conclusions and relevance: Though overall rates are low, failure to receive recommended chemotherapy is associated with sociodemographic factors. Hospital variation in failure to administer recommended chemotherapy is masked by current quality measure definitions and may define a significant and unmeasured difference in hospital quality.

AB - Background: Chemotherapy quality measures consider hospitals compliant when chemotherapy is recommended, even if it is not received. This may mask shortcomings in cancer care delivery. Objectives of this study were to (1) identify patient factors associated with failure to receive recommended chemotherapy without a documented contraindication and (2) assess hospital variation in failure to administer recommended chemotherapy. Methods: Patients from 2005 to 2015 with breast, colon and lung cancers who failed to receive recommended chemotherapy were identified using the National Cancer Database. Hospital-level rates of failure to administer recommended chemotherapy were calculated, and patient and hospital factors associated with failure to receive recommended chemotherapy were identified by multivariable logistic regression. Results: A total of 183 148 patients at 1281 hospitals were analysed. Overall, 3.5% of patients with breast, 6.6% with colon and 10.7% with lung cancers failed to receive recommended chemotherapy. Patients were less likely to receive recommended chemotherapy in all cancers if uninsured or on Medicaid (p<0.05), as were non-Hispanic black patients with both breast and colon cancer (p<0.001). Significant hospital variation was observed, with hospital-level rates of failure to administer recommended chemotherapy as high as 21.8% in breast, 40.2% in colon and 40.0% in lung cancers. Conclusions and relevance: Though overall rates are low, failure to receive recommended chemotherapy is associated with sociodemographic factors. Hospital variation in failure to administer recommended chemotherapy is masked by current quality measure definitions and may define a significant and unmeasured difference in hospital quality.

KW - health services research

KW - quality measurement

KW - surgery

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DO - 10.1136/bmjqs-2019-009742

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SN - 2044-5415

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