The mortality rates for complex cancer procedures was shown to differ significantly depending on whether the procedure took place at 1-star hospitals or 5-star hospitals.
The mortality rates for complex cancer procedures was shown to differ significantly depending on whether the procedure took place at 1-star hospitals (10.4%) or 5-star hospitals (6.4%), according to an article in the JNCI Cancer Spectrum.
The varying safety of complex cancer surgeries depending on the hospital has been widely understood for some time, according to the study. In some cases, the difference in the mortality rate for these procedures in hospitals can be as high as a 4-fold, the authors noted.
Due to this understanding regarding the varying safety of these procedures, researchers have previously suggested the importance of a shift away from allowing complex cancer procedures to be conducted at hospitals with a higher mortality risk.
However, challenges exist in the current system related to connecting patients with the correct hospital for a certain procedure. One reason for this is the lack of transparency regarding hospital volumes and surgery-specific performance data to patients and providers, according to the study.
The current star rating system was created by the Centers for Medicare and Medicaid Services (CMS) to support patients in the process of comparing the quality of each hospital's care. However, the system is not set up to be specific to any medical operation or patient population and is instead based on 62 measurements, such as mortality, readmissions, and patient experience.
Despite the lack of specificity, the study authors examined the system and concluded the ratings did correlate with quality and safety in numerous patient care scenarios, including the mortality risk following a complex cancer surgery procedure.
In the study, the researchers assessed the cases of 105,823 patients who underwent complex cancer procedures at 3146 hospitals during the period between 2013 and 2016. Patients considered eligible for inclusion in the study were over 65 years old with a diagnosis of cancer of the lung, colon, stomach, esophagus, or pancreas; such patients comprise 80% of all high-risk cancer surgeries conducted, according to the authors.
The results demonstrated that the mortality rating over a 90-day period correlated with the star system. Specifically, the most significant difference was observed between 1-star (10.4%) and 5-star (6.4%) hospitals, although these rates vary somewhat by surgery type.
Additionally, such results are supported by prior research that has found that the CMS star rating system correlates with the mortality rate of surgical procedures. Yet, the efficacy of the current system in place for choosing hospitals for complex cancer surgeries remains low at 84 lives per year.
"For complex cancer care, choosing the right hospital may be as important as choosing the right treatment," said co-author Daniel Boffa, MD, a professor of thoracic surgery at Yale School of Medicine, in a press release. "In order for patients to select the best hospital for their situation, they need access to understandable information regarding the safety and quality of hospital care. Unfortunately, the CMS star-rating system, while clear and easy to access, does not appear to distinguish the safest from the least safe hospitals with enough separation to reliably guide cancer patient choice for complex surgical care."
Study finds cancer mortality rate disparity based on hospital ratings. Oxford University Press; July 13, 2020. eurekalert.org/pub_releases/2020-07/oupu-sfc071320.php. Accessed August 18, 2020.