MP66-10 HOSPITAL-LEVEL QUALITY INDICATORS FOR KIDNEY CANCER SURGERY: A VETERAN’S AFFAIR NATIONAL HEALTH SYSTEM VALIDATION OF CONCEPT

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Quality Improvement & Patient Safety III (MP66)1 Apr 2020MP66-10 HOSPITAL-LEVEL QUALITY INDICATORS FOR KIDNEY CANCER SURGERY: A VETERAN’S AFFAIR NATIONAL HEALTH SYSTEM VALIDATION OF CONCEPT Diego Aguilar Palacios*, Brigid Wilson, Olli Saarela, Mustafa Ascha, Sunah Song, Molly E. DeWitt-Foy, Keith Lawson, Jill Barnholtz-Sloan, Antonio Finelli, Steven C. Campbell, and Robert Abouassaly Diego Aguilar Palacios*Diego Aguilar Palacios* More articles by this author , Brigid WilsonBrigid Wilson More articles by this author , Olli SaarelaOlli Saarela More articles by this author , Mustafa AschaMustafa Ascha More articles by this author , Sunah SongSunah Song More articles by this author , Molly E. DeWitt-FoyMolly E. DeWitt-Foy More articles by this author , Keith LawsonKeith Lawson More articles by this author , Jill Barnholtz-SloanJill Barnholtz-Sloan More articles by this author , Antonio FinelliAntonio Finelli More articles by this author , Steven C. CampbellSteven C. Campbell More articles by this author , and Robert AbouassalyRobert Abouassaly More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000941.010AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Validation and implementation of quality indicators (QIs) for oncological surgical care is imperative in national health care systems. However, QIs must be adjusted for significant case-mix variations among hospitals and to capture disparate patient outcomes. Here, we explore and validate a compound quality score (CQS) as a metric for hospital-level quality of care in kidney cancer patients. METHODS: Kidney cancer patients (n = 8233) treated at the VA (2005-2015) were identified. Two previously described and validated process QIs were explored: the proportion of patients with a) T1a tumors undergoing partial nephrectomy; and b) T1-T2 tumors undergoing minimally invasive radical nephrectomy. Demographics, comorbidity, tumor characteristics and treatment year were used for case-mix adjustment using indirect standardization / multivariable regression models. The predicted vs observed ratio of cases was calculated to generate each QI score. CQS represents the sum of both QIs scores. Ninety-six hospitals were benchmarked by CQS and patient-level outcomes were regressed on CQS levels to assess for length of stay (LOS), 30 days complications/readmission, 90 days overall mortality and total cost of surgical admission. RESULTS: CQS identified 25, 33 and 38 hospitals with higher, lower and average performance, respectively. Total CQS score was independently associated with LOS [β = -0.04, p< 0.01, predicted LOS 0.84 days shorter for CQS = 2 vs. CQS = -2], 30 days surgical complications [OR = 0.88, p < 0.01] or 30 days medical complications [OR = 0.93, p < 0.01] and total cost of surgical admission [β = -0.014, p< 0.01, predicted 12% lower cost for CQS = 2 vs. CQS = -2]. No association was found between CQS and 30 day readmissions or 90 days mortality (all p>0.05), although low event rates were observed (8.9% and 1.7%, respectively). CONCLUSIONS: Variability in quality of surgical care at a hospital-level can be captured with the CQS among kidney cancer patients. CQS is associated with length of stay, post-operative complications and total cost of surgical admission. Quality indicators should be used to identify, audit and implement quality improvement strategies across health systems. Source of Funding: Merit Pilot Award #PPO 17-216, VA Grant © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e986-e987 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Diego Aguilar Palacios* More articles by this author Brigid Wilson More articles by this author Olli Saarela More articles by this author Mustafa Ascha More articles by this author Sunah Song More articles by this author Molly E. DeWitt-Foy More articles by this author Keith Lawson More articles by this author Jill Barnholtz-Sloan More articles by this author Antonio Finelli More articles by this author Steven C. Campbell More articles by this author Robert Abouassaly More articles by this author Expand All Advertisement PDF downloadLoading ...