Surgeon-, pathologist-, and hospital-level variation in suboptimal lymph node examination after colectomy: Compartmentalizing quality improvement strategies

摘要: Background The goals of this study were to characterize the variation in suboptimal lymph node examination for patients with colon cancer across individual surgeons, pathologists, and hospitals examine if affects 5-year, disease-specific survival. Methods A retrospective cohort was conducted by merging New York State Cancer Registry Statewide Planning & Research Cooperative System, Medicaid, Medicare claims identify resections stages I–III from 2004–2011. Multilevel logistic regression models characterized ( Results overall rate 32% 12,332 treated 1,503 surgeons 814 pathologists at 187 hospitals. Patient-level predictors older age, male sex, nonscheduled admission, lesser stage, left colectomy procedure. Hospital-level a nonacademic status, rural setting, low annual number cancer. percent total clustering variance attributed 8%, 23%, 70%, respectively. Increasing pathologist hospital-specific rates associated worse Conclusion There large between Collaborative efforts that promote optimal nodes may improve prognosis patients. Given 93% attributable hospitals, endeavors quality improvement should focus on these 2 settings.