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Association of hospital volume and quality of care with survival for ovarian cancer

Obstetrics and Gynecology Aug 29, 2017

Wright JD, et al. – A retrospective cohort study is performed to evaluate whether strict adherence to quality metrics by hospitals could clarify the relationship between hospital volume and survival for ovarian cancer. Albeit both hospital volume and adherence to quality metrics are related to survival for ovarian cancer, low–volume hospitals that provide high–quality care still have survival rates that are lower than high–volume centers.

Methods

  • For this study, they designed a retrospective cohort study.
  • They used the National Cancer Database to perform this study.
  • From 2004 to 2013, women with ovarian cancer were enrolled in this study.
  • Hospitals were stratified by annual case volume into quintiles (2 or less, 2.01–5, 5.01–9, 9.01–19.9, 20 cases or greater) and by adherence to ovarian cancer quality metrics into quartiles.
  • Hospital–level adjusted 2– and 5–year survival rates were compared based on volume and adherence to the quality metrics.

Results

  • In this study, they identified a total of 100,725 patients at 1,268 hospitals.
  • Higher volume hospitals will probably adhere to the quality metrics.
  • Both 2– and 5–year survival increased with hospital volume and with adherence to the measured quality metrics.
  • For example, 2–year survival increased from 64.4% (95% CI 62.5–66.4%) at low–volume to 77.4% (95% CI 77.0–77.8%) at high–volume centers and from 66.5% (95% CI 65.5–67.5%) at low–quality to 77.3% (95% CI 76.8–77.7%) at high–quality hospitals (P<.001 for both).
  • For each hospital volume category, survival increased with increasing adherence to the quality metrics.
  • For example, in the lowest volume hospitals (two or less cases annually), adjusted 2–year survival was 61.4% (95% CI 58.4–64.5%) at hospitals with the lowest adherence to quality metrics and rose to 65.8% (95% CI 61.2–70.8%) at the hospitals with highest adherence to the quality metrics (P<.001).
  • However, lower volume hospitals with higher quality scores still had survival that was lower than higher volume hospitals.

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