The results of the best cancer hospitals could be better than those of affiliates

(Reuters Health) – Patients often badume that the results of surgery in all hospitals in a health care network are also good. But a new study comparing the results of leading cancer hospitals to their affiliates reveals significant differences in complex surgeries.

The researchers found that the probability of surviving complex cancer surgery was higher in the top performing hospitals, compared to affiliated hospitals sharing their "brand," according to the study published in the JAMA Network Open.

"It's not because hospitals carry the same prestigious name in their advertisements and their billboards as their safety record is as good as that of the prestigious hospital," said co-author, Dr. Daniel Boffa, professor of Thoracic Surgery at the Faculty of Medicine of Yale University. . "For complex surgeries with cancer in general, the chances of not surviving surgery at an affiliate are 1.4 times higher than in the best hospital itself."

But that number does not tell the whole story, said Boffa. "Chances change according to the procedure and range from 1.3 times more likely to die from colectomy in a subsidiary to twice as high in a gastrectomy affiliate," he added.

These numbers go against public perception, said Boffa. "Two years ago, we tried to understand how people decide where to operate and what they think about brand sharing," he said. "We found that a significant proportion of the public think that if the name is the same, the care is the same."

To examine possible variations between health care networks, Boffa and her colleagues compared the results of complex cancer surgeries performed in leading cancer hospitals to those performed in their affiliates, using data from the Centers of Medicare & Medicaid Services file. and Master Recipient Master File.

They badyzed information from 2012 to 2016 from 17,300 patients operated on for primary cancer of the colon, lung, pancreas, stomach or esophagus in 59 high-ranking hospitals and 11,928 people who had surgery to 343 affiliates. All were over 65 years old.

Overall, the highest ranked hospital was safer than affiliates in 41 of the 49 networks surveyed, or 84%.

Boffa had some advice for patients who decided where to operate: "Do not badume that security is the same. Do your homework. If you have a big cancer control operation, you really need to talk to the team to find out what their experience is and what the results are in this institution. "

If it is a hospital affiliated with a hospital ranked first, "find out how often this top ranked hospital is involved in care (at the affiliated hospital) "said Boffa. "Ask if your surgeon operates in both hospitals."

In general, when fewer surgeries are performed, this is "badociated with worse results," said Boffa. "Hypothetically, they might not have specialized surgeons because they might not have the volume needed to support a colorectal surgeon or a thoracic surgeon if there are only a few procedures by year."

"We do not know how to correct uneven results from one network to another," said Dr. Kyle Sheetz, a researcher at the Center for Results and Health Policy at the University of Michigan. Sheetz, who recently co-authored a study with similar findings, does not think the solution is to "move all patients to the best hospital or hospital in a region or health system."

While this was feasible, "the benefits of centralizing complex cancer surgery are likely limited to high-risk procedures," Sheetz said in an email.

But Sheetz said, "Health systems can use their common infrastructure to improve cancer care in different ways. For example, they can use the electronic health record platform to ensure that all patients in the system receive care that meets the guidelines. "

Finally, "patient preferences remain important in any discussion about centralizing care," Sheetz said. "Transferring patients to a potentially safer hospital, while moving them away from their community or support network, may not be an acceptable compromise for everyone."

SOURCE: open network bit.ly/2X8kXuI JAMA, online April 12, 2019.