Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Sep;130(3):545-553.
doi: 10.1097/AOG.0000000000002164.

Association of Hospital Volume and Quality of Care With Survival for Ovarian Cancer

Jason D Wright  1 , Ling Chen, June Y Hou, William M Burke, Ana I Tergas, Cande V Ananth, Alfred I Neugut, Dawn L Hershman
Affiliations

Association of Hospital Volume and Quality of Care With Survival for Ovarian Cancer

Jason D Wright et al. Obstet Gynecol. 2017 Sep.

Abstract

Objective: To assess whether strict adherence to quality metrics by hospitals could explain the association between hospital volume and survival for ovarian cancer.

Methods: We used the National Cancer Database to perform a retrospective cohort study of women with ovarian cancer from 2004 to 2013. Hospitals were stratified by annual case volume into quintiles (2 or less, 2.01-5, 5.01-9, 9.01-19.9, 20 cases or greater) and by adherence to ovarian cancer quality metrics into quartiles. Hospital-level adjusted 2- and 5-year survival rates were compared based on volume and adherence to the quality metrics.

Results: A total of 100,725 patients at 1,268 hospitals were identified. Higher volume hospitals were more likely to adhere to the quality metrics. Both 2- and 5-year survival increased with hospital volume and with adherence to the measured quality metrics. For example, 2-year survival increased from 64.4% (95% CI 62.5-66.4%) at low-volume to 77.4% (95% CI 77.0-77.8%) at high-volume centers and from 66.5% (95% CI 65.5-67.5%) at low-quality to 77.3% (95% CI 76.8-77.7%) at high-quality hospitals (P<.001 for both). For each hospital volume category, survival increased with increasing adherence to the quality metrics. For example, in the lowest volume hospitals (two or less cases annually), adjusted 2-year survival was 61.4% (95% CI 58.4-64.5%) at hospitals with the lowest adherence to quality metrics and rose to 65.8% (95% CI 61.2-70.8%) at the hospitals with highest adherence to the quality metrics (P<.001). However, lower volume hospitals with higher quality scores still had survival that was lower than higher volume hospitals.

Conclusion: Although both hospital volume and adherence to quality metrics are associated with survival for ovarian cancer, low-volume hospitals that provide high-quality care still have survival rates that are lower than high-volume centers.

PubMed Disclaimer

Conflict of interest statement

Financial Disclosure:

The other authors did not report any potential conflicts of interest.

Figures

Figure 1
Figure 1
A. Two-year adjusted survival rates stratified by volume and adherence to quality measures. B. Five-year adjusted survival rates stratified by volume and adherence to quality measures. The error bars indicate 95% confidence intervals.
See this image and copyright information in PMC

References

    1. Birkmeyer JD, Siewers AE, Finlayson EV, et al. Hospital volume and surgical mortality in the United States. N Engl J Med. 2002;346:1128–37. - PubMed
    1. Birkmeyer JD, Stukel TA, Siewers AE, Goodney PP, Wennberg DE, Lucas FL. Surgeon volume and operative mortality in the United States. N Engl J Med. 2003;349:2117–27. - PubMed
    1. Ghaferi AA, Birkmeyer JD, Dimick JB. Variation in hospital mortality associated with inpatient surgery. N Engl J Med. 2009;361:1368–75. - PubMed
    1. Wright JD, Herzog TJ, Siddiq Z, et al. Failure to rescue as a source of variation in hospital mortality for ovarian cancer. J Clin Oncol. 2012;30:3976–82. - PubMed
    1. Vernooij F, Heintz AP, Witteveen PO, van der Heiden-van der Loo M, Coebergh JW, van der Graaf Y. Specialized care and survival of ovarian cancer patients in The Netherlands: nationwide cohort study. J Natl Cancer Inst. 2008;100:399–406. - PubMed

Publication types