Top Cancer Hospitals' Outcomes May Be Better Than Affiliates'
(Reuters Health) - Patients often assume that surgical outcomes at all hospitals in a healthcare network are equally good. But a new study comparing outcomes from top-ranked cancer hospitals to their affiliates finds significant differences when it comes to complex cancer surgeries.
Researchers found that the likelihood of surviving a complex cancer surgery was greater at top-ranked cancer hospitals compared to affiliated hospitals that shared their "brand," according to the study published April 12 in JAMA Network Open.
"Just because hospitals have the same prestigious name on their advertisements and signs does not mean their safety record is as good as that of the prestigious hospital," said coauthor Dr. Daniel Boffa, a professor of thoracic surgery at Yale University School of Medicine. "For complex cancer surgery in general you have 1.4 times higher odds of not surviving the surgery at an affiliate compared to the top-ranked hospital itself."
But that number doesn't tell the whole story, Boffa said. "The odds change by procedure and range from 1.3 times higher odds of dying having a colectomy at an affiliate to two times higher at an affiliate with a gastrectomy," he added.
Those numbers fly in the face of public perception, Boffa said. "Two years ago we tried to understand how people decided where to get surgery and what they thought about brand sharing," he said. "We found that a significant proportion of the public thinks if the name is the same, the care is the same."
To look at possible variations across healthcare networks, Boffa and his colleagues compared outcomes from complex cancer surgeries performed at top-ranked cancer hospitals to those performed at their affiliates using data from the Centers for Medicare & Medicaid Services 100% Medicare Provider and Analysis Review File and Master Beneficiary Summary File.
They analyzed information from 2012-2016 from 17,300 patients who underwent complex surgery for primary cancer of the colon, lung, pancreas, stomach or esophagus at 59 top-ranked hospitals and 11,928 who received their surgeries at 343 affiliates. All were older than 65.
Overall, the top-ranked hospital was safer than its affiliates in 41 out of the 49 networks, or 84 percent, that were studied.
Boffa had some advice for patients deciding where to have surgery: "Don't assume the safety is the same. Do your homework. If you're having a big cancer operation, you really need to talk to the team and find out what is their experience and what are the outcomes at that institution."
If it's an affiliated hospital to a top-ranked one, "find out how often the top-ranked hospital is involved in care (at the affiliated hospital)," Boffa said. "Ask if your surgeon operates at both hospitals."
Generally, when fewer surgeries are performed, that's "associated with worse outcomes," Boffa said. "Hypothetically, they may not have specialty trained surgeons because they may not have the volume to support a colorectal surgeon or a thoracic surgeon if there are only a few procedures a year."
It's unclear how to fix the uneven outcomes across networks, said Dr. Kyle Sheetz, a research fellow at the Center for Health Care Outcomes and Policy at the University of Michigan. Sheetz, who recently coauthored a study with similar conclusions, doesn't think the solution is "to move all patients to the best hospital or the highest volume hospital within a region or health system."
Even if that were feasible, "the benefits of centralizing complex cancer surgery are likely restricted to the highest risk procedures," Sheetz said in an email.
But, Sheetz said, "health systems can use their common infrastructure to improve cancer care in other ways. For example, they can leverage the electronic medical record platform to ensure that all patients within the system receive guideline concordant care."
And ultimately, "patient preferences remain important to any discussion around centralizing care," Sheetz said. "Shifting patients to a potentially safer hospital, while also moving them away from their community or support network, may not be an acceptable tradeoff to everyone."
JAMA Netw Open 2019.