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. 2011 Oct;146(10):1128-34.
doi: 10.1001/archsurg.2011.141. Epub 2011 Jun 20.

Receipt of appropriate surgical care for Medicare beneficiaries with cancer

Caprice C Greenberg  1 , Stuart R Lipsitz, Bridget Neville, Haejin In, Nathanael Hevelone, Stacy A Porter, Christine Weeks, Ashish K Jha, Atul A Gawande, Deborah Schrag, Jane C Weeks
Affiliations

Receipt of appropriate surgical care for Medicare beneficiaries with cancer

Caprice C Greenberg et al. Arch Surg. 2011 Oct.

Abstract

Objective: To investigate receipt of appropriate surgical care in Medicare beneficiaries with cancer.

Design: Retrospective cohort study.

Setting: National Surveillance, Epidemiology, and End Results registry linked to Medicare claims data.

Patients: Fee-for-service Medicare patients aged 65 years or older who underwent a definitive surgical resection for breast, colon, gastric, rectal, or thyroid cancer diagnosed between January 2000 and December 2005. Claims data were available from January 1999 through December 2007.

Main outcome measures: Receipt of care concordant with established practice guidelines in surgical oncology in the aggregate and by hospital.

Results: Concordance with guidelines was greater than 90% for 7 of 11 measures. All guidelines regarding adjuvant therapy had concordance rates greater than 90%. Only 2 of 5 measures for nodal management had concordance rates greater than 90%. At least 50% of hospitals provided guideline-concordant care to 100% of their patients for 6 of 11 guidelines. Patients receiving appropriate care tended to be younger, healthier, white, and more affluent, to have less advanced disease, and to live in the Midwest.

Conclusions: We found a high level of concordance with guidelines in some domains of surgical oncology care but far less so in others, particularly for gastric and colon nodal management. Given the current national focus on improving the quality of health care, surgeons must focus on generating data to define appropriate care and translating those data into everyday practice.

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Figures

Figure 1
Figure 1. Cohort Identification
The first box represents all cases of cancer identified within the dataset for each disease site. The second box depicts the cohort for each disease site after general restrictions. The final box represents the cohort for each guideline following guideline-specific criteria. These guideline-specific cohorts are not mutually exclusive and may overlap since more than one guideline may be applicable to a given patient.
Figure 2
Figure 2. Hospital Distribution of 100% Concordance for Each Guideline
The graph depicts the percentage of hospitals with ≥5 case volume providing guideline concordant care to 100% of eligible patients treated.
See this image and copyright information in PMC

References

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