Assessment of hospital quality and safety standards among Medicare beneficiaries undergoing surgery for cancer

Abstract

BackgroundWe sought to assess the relationship between Leapfrog minimum volume standards, Hospital Safety Grades, and Magnet recognition with outcomes among patients undergoing rectal, lung, esophageal, and pancreatic resection for cancer. MethodsStandard Analytical Files linked with the Leapfrog Hospital Survey and the Leapfrog Safety Scores Denominator Files were used to identify Medicare patients who underwent surgery for cancer from 2016 to 2017. Multivariable logistic regression analysis was used to examine textbook outcomes relative to Leapfrog volume, safety grades, and Magnet recognition. ResultsAmong 26,268 Medicare beneficiaries, 7,491 (28.5%) were treated at hospitals meeting the quality trifactor (Leapfrog, safety grade A, and Magnet recognition) vs 18,777 (71.5%) at hospitals not meeting ≥1 designation. Patients at trifactor hospitals had lower odds of complications (odds ratio = 0.83, 95% confidence interval: 0.76–0.89), prolonged duration of stay (odds ratio = 0.89, 95% confidence interval: 0.82–0.97), and higher odds of experiencing textbook outcome (odds ratio = 1.12, 95% confidence interval: 1.06–1.19). Patients undergoing surgery for lung (odds ratio = 1.19, 95% confidence interval: 1.10–1.30) and pancreatic cancer (odds ratio = 1.37, 95% confidence interval: 1.21–1.55) at trifactor hospitals had higher odds of textbook outcome, whereas this effect was not noted after esophageal (odds ratio = 1.16, 95% confidence interval: 0.90–1.48) or rectal cancer (odds ratio = 1.11, 95% confidence interval: 0.98–1.27) surgery. Leapfrog minimum volume standards mediated the effect of the quality trifactor on patient outcomes. ConclusionQuality trifactor hospitals had better short-term outcomes after lung and pancreatic cancer surgery compared with nontrifactor hospitals.