Outcomes for urologic oncology procedures: are there differences between academic and community hospitals?

Syed, Jamil; Abello, Alejandro; Nguyen, Justin; Lee, Aidan J H; Desloges, Juan-Javier; Leapman, Michael; Kenney, Patrick A.

doi:10.1007/s00345-019-02902-8

Cited by 8 publications

(7 citation statements)

References 38 publications

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“…Survival of patients admitted to major teaching hospitals exceeded that of patients admitted to nonteaching hospitals by more than 10%. One study contradicts these findings, but it used in‐hospital mortality as the outcome measure, and “teaching hospital” was not precisely defined 32 …”

Section: Discussionmentioning

confidence: 99%

“…Several studies have analyzed longer-term (two-to five-year) survival of patients diagnosed with specific types of cancer (Table 2). [26][27][28][29][30][31][32] Not only is the longer-term follow-up a strength, but these studies controlled for attributes of the tumor not in claims data-for example, tumor stage, grade, depth, 30 and size 26 at initial diagnosis. These studies also tended to control for surgical procedure volume.…”

Section: Discussionmentioning

confidence: 99%

“…One study contradicts these findings, but it used in-hospital mortality as the outcome measure, and "teaching hospital" was not precisely defined. 32 Another condition for which detailed data are available is AMI, in particular from the CCP. Using data from the CCP, Allison et al reported that patient characteristics (e.g., Charlson score; APACHE II score; percentages of patients with diabetes, hypertension, chronic renal insufficiency, CHF) did not differ much by hospital teaching status and were sometimes more adverse for nonteaching hospitals.…”

Section: Discussionmentioning

confidence: 99%

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Quality and Cost of Care by Hospital Teaching Status: What Are the Differences?

Sloan

2021

Milbank Quarterly

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In two respects, quality of care tends to be higher at major teaching hospitals: process of care and long‐term survival of cancer patients following initial diagnosis. There is also evidence that short‐term (30‐day) mortality is lower on average at such hospitals, although the quality of evidence is somewhat lower. Quality of care is mulitdimensional. Empirical evidence by teaching status on dimensions other than survival is mixed. Higher Medicare payments for care provided by major teaching hospitals are partially offset by lower payments to nonhospital providers. Nevertheless, the payment differences between major teaching and nonteaching hospitals for hospital stays, especially for complex cases, potentially increase prices other insurers pay for hospital care. Context The relative performance of teaching hospitals has been discussed for decades. For private and public insurers with provider networks, an issue is whether having a major teaching hospital in the network is a “must.” For traditional fee‐for‐service Medicare, there is an issue of adequacy of payment of hospitals with various attributes, including graduate medical education (GME) provision. Much empirical evidence on relative quality and cost has been published. This paper aims to (1) evaluate empirical evidence on relative quality and cost of teaching hospitals and (2) assess what the findings indicate for public and private insurer policy. Methods Complementary approaches were used to select studies for review. (1) Relevant studies highly cited in Web of Science were selected. (2) This search led to studies cited by these studies as well as studies that cited these studies. (3) Several literature reviews were helpful in locating pertinent studies. Some policy‐oriented papers were found in Google under topics to which the policy applied. (4) Several papers were added based on suggestions of reviewers. Findings Quality of care as measured in process of care studies and in longitudinal studies of long‐term survival of cancer patients tends to be higher at major teaching hospitals. Evidence on survival at 30 days post admission for common conditions and procedures also tends to favor such hospitals. Findings on other dimensions of relative quality are mixed. Hospitals with a substantial commitment to graduate medical education, major teaching hospitals, are about 10% to 20% more costly than nonteaching hospitals. Private insurers pay a differential to major teaching hospitals at this range's lower end. Inclusive of subsidies, Medicare pays major teaching hospitals substantially more than 20% extra, especially for complex surgical procedures. Conclusions Based on the evidence on quality, there is reason for patients to be willing to pay more for inclusion of major teaching hospitals in private insurer networks at least for some services. Medicare payment for GME has long been a controversial policy issue. The actual indirect cost of GME is likely to be far less than the amount Medicare is currently paying hospitals.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Quality and Cost of Care by Hospital Teaching Status: What Are the Differences?

Sloan

2021

Milbank Quarterly

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“…This retrospective analysis of nearly 120,000 patient cases (33% of whom were treated at affiliated community centers) concluded that perioperative mortality was higher at affiliate centers than at the tertiary centers and that long‐term survival was significantly lower at affiliate practices. Additional work from Syed et al has demonstrated that length of stay for certain urologic cancer surgeries was shorter in the tertiary setting as compared to community practice 17 …”

Section: Discussionmentioning

confidence: 99%

“…Additional work from Syed et al has demonstrated that length of stay for certain urologic cancer surgeries was shorter in the tertiary setting as compared to community practice. 17 These studies are both in the domain of surgical oncology, while our study is medical oncology focused. While we do not directly interrogate patient outcomes between tertiary and community sites, differences in utility of genomic profiling platforms and availability of clinical trials between the settings were noted in our survey responses, which may influence clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

Characterizing the relationships between tertiary and community cancer providers: Results from a survey of medical oncologists in Southern California

et al. 2021

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Background Tertiary cancer centers offer clinical expertise and multi‐modal approaches to treatment alongside the integration of research protocols. Nevertheless, most patients receive their cancer care at community practices. A better understanding of the relationships between tertiary and community practice environments may enhance collaborations and advance patient care. Methods A 31‐item survey was distributed to community and tertiary oncologists in Southern California using REDCap. Survey questions assessed the following attributes: demographics and features of clinical practice, referral patterns, availability and knowledge of clinical trials and precision medicine, strategies for knowledge acquisition, and integration of community and tertiary practices. Results The survey was distributed to 98 oncologists, 85 (87%) of whom completed it. In total, 52 (61%) respondents were community practitioners and 33 (38%) were tertiary oncologists. A majority (56%) of community oncologists defined themselves as general oncologists, whereas almost all (97%) tertiary oncologists reported a subspecialty. Clinical trial availability was the most common reason for patient referrals to tertiary centers (73%). The most frequent barrier to tertiary referral was financial considerations (59%). Clinical trials were offered by 97% of tertiary practitioners compared to 67% of community oncologists (p = 0.001). Most oncologists (82%) reported only a minimal‐to‐moderate understanding of clinical trials available at regional tertiary centers. Conclusions Community oncologists refer patients to tertiary centers primarily with the intent of clinical trial enrollment; however, significant gaps exist in their knowledge of trial availability. Our results identify the need for enhanced communication and collaboration between community and tertiary providers to expand patients’ access to clinical trials.

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