The influence of facility volume on patient treatments and survival outcomes in nasopharyngeal carcinoma

Goshtasbi, Khodayar; Abiri, Arash; Lehrich, Brandon M.; Haidar, Yarah M.; Tjoa, Tjoson; Kuan, Edward C.

doi:10.1002/hed.26739

Cited by 12 publications

(18 citation statements)

References 52 publications

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“…A growing body of literature supports a positive association between hospital case volume and treatment outcomes for a variety of malignancies. [5][6][7][8][9][10][11][28][29][30][31][32][33] Importantly, volume itself does not drive outcomes but acts as a proxy for underlying factors more directly linked to quality of care. 25 For example, HVFs tend to show greater adherence to evidence-based guidelines, utilize advanced multidisciplinary care teams with specialized expertise, and have access to novel technologies and therapeutics.…”

Section: Discussionmentioning

confidence: 99%

“…A growing body of literature supports a positive association between hospital case volume and treatment outcomes for a variety of malignancies 5–11,28–33 . Importantly, volume itself does not drive outcomes but acts as a proxy for underlying factors more directly linked to quality of care 25 .…”

Section: Discussionmentioning

confidence: 99%

“…In recent years, hospital case volume has emerged as a prognostic factor for a variety of cancers. Population‐based analyses have reported a positive association between case volume and treatment outcomes for pathologies as diverse as testicular cancer, 5 nonsmall cell lung cancer, 6 nasopharyngeal carcinoma, 7 and head and neck (HN) squamous cell carcinoma, 8 among others 9,10 . Previous studies have demonstrated that facility case load predicts overall survival (OS) in cutaneous melanoma in general 11,12 .…”

Section: Introductionmentioning

confidence: 99%

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Case volume regionalization and volume‐based outcome differences in cutaneous head and neck melanoma

et al. 2022

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Background Hospital volume has emerged as a prognostic factor in oncology but is not currently known whether volume is associated with improved outcomes for cutaneous head and neck (HN) melanoma. Methods A total of 556 079 cutaneous melanoma cases reported by the 2004–2016 National Cancer Database were separated into two cohorts (HN and non‐HN) and facilities within each cohort were classified by case volume. Analysis employed chi‐square, analysis of variance, Kaplan–Meier, and Cox proportional hazards models. Results Only 41 facilities (3.1% of 1326) treating HN melanoma and 50 facilities (3.7% of 1344) treating non‐HN melanoma were classified as high‐volume facilities (HVFs). The estimated 5‐year overall survival (OS) was 62.7% (standard error [SE]: 0.4%) for patients with HN at low‐volume facilities (LVFs), 69.3% (SE: 0.4%) at IVFs, and 71.8% (SE 0.4%) at HVFs (p < 0.001). Differences in OS remained significant between HVFs versus LVFs after adjusting for confounders. Conclusion Volume is independently associated with OS and improved surgical outcomes for HN melanoma.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Case volume regionalization and volume‐based outcome differences in cutaneous head and neck melanoma

et al. 2022

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“…Prognostic associations between facility volume and various outcome measures of head and neck malignancies have been previously reported. 10,12,[24][25][26] However, to our knowledge, this study is the first to determine a systematic, data-driven facility case-volume threshold informed by population-based patient survival data for locally advanced PTC. Using LVF (<27 cases/year) and HVF (≥27 cases/year) as prognostic case-volume designations, our analysis demonstrated that high facility case-volume, representing approximately the top 1.2% of facilities in our cohort, was an independent predictor of overall survival in locally advanced PTC.…”

Section: Discussionmentioning

confidence: 99%

“…Possible explanations include greater adherence to clinical guidelines, utilization of specialized multidisciplinary care teams, and greater access to advanced technologies and treatments at high volume "centers of excellence" compared to community hospitals. 10,[13][14][15][16] As locally advanced PTC requires a high level of surgical expertise and effective coordination of care between different medical specialists, patients may benefit from treatment at high volume institutions. However, to date, no study has investigated the impact of facility case-volume on survival outcomes in this patient population.…”

Section: Introductionmentioning

confidence: 99%

Facility Volume as a Prognosticator of Survival in Locally Advanced Papillary Thyroid Cancer

et al. 2022

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Objectives To evaluate the influence of facility case‐volume on survival in patients with locally advanced papillary thyroid cancer (PTC), and to identify prognostic case‐volume thresholds for facilities managing this patient population. Study Design Retrospective database study. Methods The 2004–2017 National Cancer Database was queried for patients receiving definitive surgery for locally advanced PTC. Using K‐means clustering and multivariable Cox proportional‐hazards (CPH) regression, two groups with distinct spectrums of facility case‐volumes were generated. Multivariable CPH regression and Kaplan–Meier analysis assessed for the influence of facility case‐volume and the prognostic value of its stratification on overall survival (OS). Results Of 48,899 patients treated at 1304 facilities, there were 34,312 (70.2%) females and the mean age was 48.0 ± 16.0 years. Increased facility volume was significantly associated with reduced all‐cause mortality (HR 0.996; 95% CI, 0.992–0.999; p = 0.008). Five facility clusters were generated, from which two distinct cohorts were identified: low (LVF; <27 cases/year) and high (HVF; ≥27 cases/year) facility case‐volume. Patients at HVFs were associated with reduced mortality compared to those at LVFs (HR 0.791; 95% CI, 0.678–0.923, p = 0.003). Kaplan–Meier analysis of propensity score‐matched N0 and N1 patients demonstrated higher OS in HVF cohorts (all p < 0.001). Conclusions Facility case‐volume was an independent predictor of improved OS in locally advanced PTC, indicating a possible survival benefit at high‐volume medical centers. Specifically, independent of a number of sociodemographic and clinical factors, facilities that treated ≥27 cases per year were associated with increased OS. Patients with locally advanced PTC may, therefore, benefit from referrals to higher‐volume facilities. Level of Evidence 4 Laryngoscope, 133:443–450, 2023

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Clinical Productivity and Patient Complexity of Academic Rhinologists: An Analysis of Medicare Metrics

Warn,

Torabi,

Bitner

et al. 2024

The Laryngoscope

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IntroductionCurrent data regarding reimbursement trends in Medicare services and the complexity of patients treated as physicians' progress in their academic career are conflicting. In otolaryngology, there are no data examining these metrics.MethodsMedicare services, reimbursement, and patient complexity risk scores (based on hierarchical condition category coding) of US rhinology fellowship‐trained faculty were stratified and compared by rank and years in practice.ResultsA cohort of 209 rhinologists were included. Full professors were reimbursed more per service than assistant professors ($791.53 [$491.69–1052.46] vs. $590.34 [$429.91–853.07] p = 0.045) and had lower risk scores (1.37 [1.26–1.52] vs. 1.49 [1.29–1.68], p = 0.013). Full professors had similar risk scores to associate professors (1.47 [1.25–1.64], p = 0.14). Full professors ($791.53 [$491.69–1,052.46], p < 0.001), associate professors ($706.85 [$473.48–941.15], p < 0.001), and assistant professors ($590.34 [$429.91–853.07], p < 0.001) were all reimbursed more per service than non‐ranked faculty ($326.08 [$223.37–482.36]). As a cohort, significant declines in risk scores occurred within the 10th–14th year of practice (p = 0.032) and after the 20th year (p = 0.038). Years in practice were inversely correlated with risk score (R = −0.358, p < 0.001).ConclusionFull professors were reimbursed more per service and treated less comorbid Medicare patients than junior academic colleagues. Patient comorbidity was correlated negatively with years in practice, with significant drops in mid and late career. Rhinologists employed at academic institutions had greater total reimbursement and reimbursement per service than non‐ranked faculty.Level of EvidenceN/A Laryngoscope, 2024

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The influence of facility volume on patient treatments and survival outcomes in nasopharyngeal carcinoma

Cited by 12 publications

References 52 publications

Case volume regionalization and volume‐based outcome differences in cutaneous head and neck melanoma

Case volume regionalization and volume‐based outcome differences in cutaneous head and neck melanoma

Facility Volume as a Prognosticator of Survival in Locally Advanced Papillary Thyroid Cancer

Clinical Productivity and Patient Complexity of Academic Rhinologists: An Analysis of Medicare Metrics

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