Identifying Opportunities to Deliver High-Quality Cancer Care Across a Health System: A Clinical Responsibility

Hemali P Shah; Oded Cohen; Alexandra T Bourdillon; Barbara A Burtness; Daniel J Boffa; Melissa Young; Benjamin L Judson; Saral Mehra

doi:10.1002/ohn.755

Identifying Opportunities to Deliver High-Quality Cancer Care Across a Health System: A Clinical Responsibility

Otolaryngol Head Neck Surg. 2024 Apr 12. doi: 10.1002/ohn.755. Online ahead of print.

Authors

Hemali P Shah^{1

2}, Oded Cohen^{2

3

4}, Alexandra T Bourdillon^{2

5}, Barbara A Burtness^{3

6}, Daniel J Boffa^{3

7}, Melissa Young⁸, Benjamin L Judson^{2

3}, Saral Mehra^{2

3}

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA.
² Division of Otolaryngology-Head and Neck Surgery, Yale Department of Surgery, New Haven, Connecticut, USA.
³ Yale Cancer Center, New Haven, Connecticut, USA.
⁴ Department of Otolaryngology-Head and Neck Surgery, Ben Gurion University of the Negev Samson Assuta Ashdod University Hospital, Ashdod, Israel.
⁵ Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco School of Medicine, San Francisco, California, USA.
⁶ Division of Medical Oncology, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA.
⁷ Section of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA.
⁸ Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut, USA.

PMID: 38606669
DOI: 10.1002/ohn.755

Abstract

Objective: We examined process-related quality metrics for oral squamous cell carcinoma (OSCC) depending on treating facility type across a health system and region.

Study design: Retrospective in accordance with Strengthening the Reporting of Observational Studies in Epidemiology guidelines.

Setting: Single health system and region.

Methods: Patients with OSCC diagnosed between 2012 and 2018 were identified from tumor registries of 6 hospitals (1 academic and 5 community) within a single health system. Patients were categorized into 3 care groups: (1) solely at the academic center, (2) solely at community facilities, and (3) combined care at academic and community facilities. Primary outcome measures were process-related quality metrics: positive surgical margin rate, lymph node yield (LNY), adjuvant treatment initiation ≤6 weeks, National Comprehensive Cancer Network (NCCN)-guideline adherence.

Results: A total of 499 patients were included: 307 (61.5%) patients in the academic-only group, 101 (20.2%) in the community-only group, and 91 (18.2%) in the combined group. Surgery at community hospitals was associated with increased odds of positive surgical margins (11.9% vs 2.5%, odds ratio [OR]: 47.73, 95% confidence interval [CI]: 11.2-275.86, P < .001) and lower odds of LNY ≥ 18 (52.8% vs 85.9%, OR: 0.15, 95% CI: 0.07-0.33, P < .001) relative to the academic center. Compared with the academic-only group, odds of adjuvant treatment initiation ≤6 weeks were lower for the combined group (OR: 0.30, 95% CI: 0.13-0.64, P = .002) and odds of NCCN guideline-adherent treatment were lower in the community only group (OR: 0.35, 95% CI: 0.18-0.70, P = .003).

Conclusion: Quality of oral cancer care across the health system and region is comparable to or better-than national standards, indicating good baseline quality of care. Differences by facility type and fragmentation of care present an opportunity for bringing best in-class cancer care across an entire region.

Keywords: adjuvant treatment; guideline adherence; health systems; lymph node yield; oral cancer; process metrics; quality of care; surgical margins; treatment setting.