Assessment of Between-Hospital Variation in Readmission and Mortality After Cancer Surgical Procedures

摘要: Importance Although current federal quality improvement programs do not include cancer surgery, the Centers for Medicare & Medicaid Services and other payers are considering extending readmission reduction initiatives to these common high-cost episodes. Objectives To quantify between-hospital variation in quality-related outcomes identify hospital characteristics associated with high low performance. Design, Setting, Participants This retrospective cohort study obtained data through linkage of California Cancer Registry discharge claims databases maintained by Office Statewide Health Planning Development. All 351 acute care hospitals at which 1 or more adults underwent curative intent surgery between January 1, 2007, December 31, 2011, analyses finalized July 15, 2018, were included. A total 138 799 undergoing colorectal, breast, lung, prostate, bladder, thyroid, kidney, endometrial, pancreatic, liver, esophageal within 6 months diagnosis, an American Joint Committee on stage I III Main Outcomes Measures included adjusted odds ratios variance components from hierarchical mixed-effects logistic regression in-hospital mortality, 90-day readmission, as well hospital-specific risk-adjusted rates standardized rate a mean annual surgical volume 10 more. Results Across patients hospitals, 8.9% aged 18 44 years 45.9% 65 older, 57.4% women, 18.2% nonwhite. Among these, 1240 (0.9%) died during index admission. 137 559 discharged alive, 19 670 (14.3%) readmitted 1754 (1.3%) 90 days. After adjusting patient case-mix differences, evidence statistically significant risk across was identified, characterized random effects mixed model, all 3 metrics (P  Conclusions Relevance Accounting there appears be substantial mortality after procedures. Recognizing multifaceted nature performance consideration simultaneously may help prioritize strategies improving outcomes.