Institutional-Level Differences in Quality and Outcomes of Lung Cancer Resections in the United States.

摘要: Background Institutional-level disparities in non-small cell lung cancer (NSCLC) survival may be driven by reversible differences care-delivery processes. We quantified the impact of readily identifiable quality metrics on long-term resected NSCLC. Research Question How do oncologic care contribute to institutional-level early-stage NSCLC survival? Study Design and Methods retrospectively analyzed patients National Cancer Data Base who underwent resection from 2004 through 2015 within institutions categorized as Community, Comprehensive Integrated Network, Academic, Institute (NCI)-Designated Programs. estimated percentages adjusted ORs for six potentially avoidable poor-quality markers: incomplete resection, nonexamination lymph nodes, nonanatomic non-evidence-based use adjuvant chemotherapy, radiation therapy, 60-day postoperative mortality. By sequentially eliminating with markers calculating hazard ratios, we their overall impact. Results Of 169,775 patients, 7%, 46%, 10%, 24%, 12% underwent surgery at NCI-Designated Programs, 5-year rates 52%, 56%, 58%, 60% and 66%, respectively. After sequential elimination process, using Centers a reference, ratio changed 1.47 (95% CI, 1.41-1.53), 1.29 1.25-1.33), 1.18 1.14-1.23), 1.20 1.16-1.24) Networks, Academic Programs 1.35 1.28-1.42), 1.22 1.17-1.26), 1.16 1.11-1.22), 1.17 1.12-1.21), respectively (P  Interpretation Targeting identified narrowed, but did not eliminate, institutional disparities. The greatest was community programs. Residual factors driving persistent institution-level must characterized eliminate them.