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01-04-2018 | Health Services Research and Global Oncology

Association of Delivery System Integration and Outcomes for Major Cancer Surgery

Authors: Jonathan Li, BSE, Zaojun Ye, MS, James M. Dupree, MD, MPH, Brent K. Hollenbeck, MD, MS, Hye Sung Min, MS, Deborah Kaye, MD, Lindsey A. Herrel, MD, MS, David C. Miller, MD, MPH, Chad Ellimoottil, MD, MS

Published in: Annals of Surgical Oncology | Issue 4/2018

Abstract

Background

Integrated delivery systems (IDSs) are postulated to reduce spending and improve outcomes through successful coordination of care across multiple providers. Nonetheless, the actual impact of IDSs on outcomes for complex multidisciplinary care such as major cancer surgery is largely unknown.

Methods

Using 2011–2013 Medicare data, this study identified patients who underwent surgical resection for prostate, bladder, esophageal, pancreatic, lung, liver, kidney, colorectal, or ovarian cancer. Rates of readmission, 30-day mortality, surgical complications, failure to rescue, and prolonged hospital stay for cancer surgery were compared between patients receiving care at IDS hospitals and those receiving care at non-IDS hospitals. Generalized estimating equations were used to adjust results by cancer type and patient- and hospital-level characteristics while accounting for clustering of patients within hospitals.

Results

The study identified 380,053 patients who underwent major resection of cancer, with 38% receiving care at an IDS. Outcomes did not differ between IDS and non-IDS hospitals regarding readmission and surgical complication rates, whereas only minor differences were observed for 30-day mortality (3.5% vs 3.2% for IDS; p < 0.001) and prolonged hospital stay (9.9% vs 9.2% for IDS; p < 0.001). However, after adjustment for patient and hospital characteristics, the frequencies of adverse perioperative outcomes were not significantly associated with IDS status.

Conclusions

The collective findings suggest that local delivery system integration alone does not necessarily have an impact on perioperative outcomes in surgical oncology. Moving forward, stakeholders may need to focus on surgical and oncology-specific methods of care coordination and quality improvement initiatives to improve outcomes for patients undergoing cancer surgery.

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Title: Association of Delivery System Integration and Outcomes for Major Cancer Surgery
Authors: Jonathan Li, BSE
Zaojun Ye, MS
James M. Dupree, MD, MPH
Brent K. Hollenbeck, MD, MS
Hye Sung Min, MS
Deborah Kaye, MD
Lindsey A. Herrel, MD, MS
David C. Miller, MD, MPH
Chad Ellimoottil, MD, MS
Publication date: 01-04-2018
Publisher: Springer International Publishing
Published in: Annals of Surgical Oncology / Issue 4/2018
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-017-6312-6

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Association of Delivery System Integration and Outcomes for Major Cancer Surgery

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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