Hospital characteristics associated with maintenance or improvement of guideline-recommended lymph node evaluation for colon cancer

Helen M. Parsons, James W. Begun, Patricia M. McGovern, Todd M. Tuttle, Karen M. Kuntz, Beth A. Virnig

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background: Over the past 20 years, surgical practice organizations have recommended the identification of '12 lymph nodes from surgically treated colon cancer patients as an indicator of quality performance for adequate staging; however, studies suggest that significant variation exists among hospitals in their level of adherence to this recommendation. We examined hospital-level factors that were associated with institutional improvement or maintenance of adequate lymph node evaluation after the introduction of surgical quality guidelines. Research Design: Using the 1996-2007 SEER-Medicare data, we evaluated hospital characteristics associated with short-term (1999-2001), medium-term (2002-2004), and long-term (2005-2007) guideline-recommended ('12) lymph node evaluation compared with initial evaluation levels (1996-1998) using χ tests and multivariate logistic regression analysis, adjusting for patient case-mix. Results: We identified 228 hospitals that performed '6 colon cancer surgeries during each study period from 1996-2007. In the initial study period (1996-1998), 26.3% (n=60) of hospitals were performing guideline-recommended evaluation, which increased to 28.1% in 1999-2001, 44.7% in 2002-2004, and 70.6% in 2005-2007. In multivariate analyses, a hospital's prior guideline performance [odds ratio (OR) (95% confidence interval (CI)): 4.02 (1.92, 8.42)], teaching status [OR (95% CI): 2.33 (1.03, 5.28)], and American College of Surgeon's Oncology Group membership [OR (95% CI): 3.39 (1.39, 8.31)] were significantly associated with short-term guideline-recommended lymph node evaluation. Prior hospital performance [OR (95% CI): 2.41 (1.17, 4.94)], urban location [OR (95% CI): 2.66 (1.12, 6.31)], and American College of Surgeon's Oncology Group membership [OR (95% CI): 6.05 (2.32, 15.77)] were associated with medium-term performance; however, these factors were not associated with long-term performance. Conclusions: Over the 12-year period, there were marked improvements in hospital performance for guideline-recommended lymph node evaluation. Understanding patterns in improvement over time contributes to debates over optimal designs of quality-improvement programs.

Original languageEnglish (US)
Pages (from-to)60-67
Number of pages8
JournalMedical Care
Volume51
Issue number1
DOIs
StatePublished - Jan 2013

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Colonic Neoplasms
Lymph Nodes
Maintenance
Guidelines
Odds Ratio
Confidence Intervals
Diagnosis-Related Groups
Medicare
Quality Improvement
Teaching
Research Design
Multivariate Analysis
Logistic Models
Regression Analysis
Organizations

Keywords

  • Colon cancer
  • hospital characteristics
  • lymph node evaluation
  • quality improvement

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

Hospital characteristics associated with maintenance or improvement of guideline-recommended lymph node evaluation for colon cancer. / Parsons, Helen M.; Begun, James W.; McGovern, Patricia M.; Tuttle, Todd M.; Kuntz, Karen M.; Virnig, Beth A.

In: Medical Care, Vol. 51, No. 1, 01.2013, p. 60-67.

Research output: Contribution to journalArticle

Parsons, Helen M. ; Begun, James W. ; McGovern, Patricia M. ; Tuttle, Todd M. ; Kuntz, Karen M. ; Virnig, Beth A. / Hospital characteristics associated with maintenance or improvement of guideline-recommended lymph node evaluation for colon cancer. In: Medical Care. 2013 ; Vol. 51, No. 1. pp. 60-67.
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N2 - Background: Over the past 20 years, surgical practice organizations have recommended the identification of '12 lymph nodes from surgically treated colon cancer patients as an indicator of quality performance for adequate staging; however, studies suggest that significant variation exists among hospitals in their level of adherence to this recommendation. We examined hospital-level factors that were associated with institutional improvement or maintenance of adequate lymph node evaluation after the introduction of surgical quality guidelines. Research Design: Using the 1996-2007 SEER-Medicare data, we evaluated hospital characteristics associated with short-term (1999-2001), medium-term (2002-2004), and long-term (2005-2007) guideline-recommended ('12) lymph node evaluation compared with initial evaluation levels (1996-1998) using χ tests and multivariate logistic regression analysis, adjusting for patient case-mix. Results: We identified 228 hospitals that performed '6 colon cancer surgeries during each study period from 1996-2007. In the initial study period (1996-1998), 26.3% (n=60) of hospitals were performing guideline-recommended evaluation, which increased to 28.1% in 1999-2001, 44.7% in 2002-2004, and 70.6% in 2005-2007. In multivariate analyses, a hospital's prior guideline performance [odds ratio (OR) (95% confidence interval (CI)): 4.02 (1.92, 8.42)], teaching status [OR (95% CI): 2.33 (1.03, 5.28)], and American College of Surgeon's Oncology Group membership [OR (95% CI): 3.39 (1.39, 8.31)] were significantly associated with short-term guideline-recommended lymph node evaluation. Prior hospital performance [OR (95% CI): 2.41 (1.17, 4.94)], urban location [OR (95% CI): 2.66 (1.12, 6.31)], and American College of Surgeon's Oncology Group membership [OR (95% CI): 6.05 (2.32, 15.77)] were associated with medium-term performance; however, these factors were not associated with long-term performance. Conclusions: Over the 12-year period, there were marked improvements in hospital performance for guideline-recommended lymph node evaluation. Understanding patterns in improvement over time contributes to debates over optimal designs of quality-improvement programs.

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