The use of procedure-specific hospital performance as the primary factor in selection of a local hospital for colorectal cancer (CRC) operation is associated with improved patient outcomes, according to a study in JAMA Network Open.
Researchers used a welfarist approach to assess the economic implications of using procedure-specific outcomes to guide hospital selection for CRC operation.
The analysis included adult patients aged 18 years and older who underwent elective resection for a colorectal neoplasm in Florida from January 1, 2016, to December 31, 2019, based on data from the Florida Agency for Health Care Administration.
Participants were grouped into 2 cohorts based on treatment year to model future hospital performance according to previous risk-adjusted outcomes. Previous hospital performance was evaluated in a training cohort who received treatment from January 1, 2016, to December 31, 2018. Estimated costs and benefits of care at alternative hospitals were assessed in a testing cohort who were treated in 2019.
The study’s primary outcome was the mean patient-level change in social welfare achieved by simulated data-driven hospital selection. Data analyses were conducted from March to October 2022.
A total of 21,098 patients (mean [SD] age, 67.3[12.0] years; women, 48.9%; White, 89.4%) were included. Of the cohort, 16,098 (76.3%) participants were in the training group and 5000 (23.7%) were in the testing group. The patients were treated at 178 hospitals, of which 177 (99.4%) were in urban locations.
Study authors identified an alternative higher-performing local hospital for 3057 of 5000 patients (61.1% in the testing cohort). Patients who were moved to a higher-performing local hospital were more likely to be men (54.3% vs 46.1%; P <.001), older (69.5[11.4] years vs 65.0[12.0] years; P <.001), and be Medicare beneficiaries (71.4% vs 54.1%; P <.001), compared with those who stayed at their chosen local hospital.
At the hospital level, 106 hospitals (59.6%) had a net volume increase, and 72 (40.4%) had a loss or no change in volume. Social welfare increased at the patient level by a mean of $1953 (95% CI, $1744-$2162) per patient at the simulated highest-performing local hospitals. Social welfare changes were associated with a reduction in-hospital mortality risk from 0.91% (95% CI, 0.80%-1.01%) at the chosen hospital to 0.67% (95% CI, 0.57%-0.76%) at the simulated highest-performing hospital. The relative reduction was 26.5% (95% CI, 24.5%-29.0%), and the absolute reduction was 0.24% (95% CI, 0.23%-0.25%). The estimated costs of care increased by $482 (95% CI, $325-$638), although it was offset by the additional life gained.
In analysis stratified by race and ethnicity, among 513 Black patients in the testing cohort, 309 (60.2%) were identified as having a higher-performing hospital. Among Black patients, simulated reassignment to an alternative hospital was associated with a 23.5% (95% CI, 19.3%-32.9%) relative decrease and 0.26% (95% CI, 0.21%-0.30%) absolute decrease in mortality risk. Black patients had mean social welfare gains of $2427 (95% CI, $1697-$3158) vs $1899 (95% CI, $1682-$2116) for White patients.
Study limitations include the population from 1 state who underwent elective operations. Also, the data lacked detailed oncologic staging, which would have facilitated life expectancy estimation. In addition, the study did not address potential racial disparities in surgical referral or treatment use, and the true benefits of data-driven hospital selection may be underestimated by assessing only in-hospital mortality during the index admission for operation.
“The study supported the use of outcomes data by patients and referring physicians to make an informed decision when selecting a hospital for care,” the study authors noted. “If the benefits simulated in this study translated to improved outcomes in practice, this approach to hospital choice could be used to transform care and guide policy in colorectal cancer surgery.”
Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Finn CB, Wirtalla C, Roberts SE, et al. Comparison of simulated outcomes of colorectal cancer surgery at the highest-performing vs chosen local hospitals. JAMA Netw Open. 2023;6(2):e2255999. doi:10.1001/jamanetworkopen.2022.55999