Cancer surgery is associated with high operative mortality rates, particularly at hospitals with low procedure volumes. Efforts to improve quality at these centers are hindered by lack of understanding about mechanisms responsible for observed volume-outcome relationships. This study will approach this question in 3 steps: 1. Determine what's different between high volume and low volume hospitals. Using 100% national samples from the 1994-2001 Medicare database (n approximately 800,000), we will compare structure and process variables at high and low volume hospitals with each of 8 procedures. Structural variables specific to cancer care will include on-site availability of radiation and chemotherapy services, hospital participation in cancer trials, and surgeon """"""""specialization"""""""" in cancer surgery. We will then assess variables related to patient selection and other processes of perioperative care. 2. Identify, which factors help explain observed volume-outcome relationships. We will then examine relationships between structure, process, and outcomes (operative mortality) with the 8 procedures. Using nested models, we will assess how observed volume-outcome relationships change as various structural and process of care variables are added to the model. We will repeat these analyses using the SEER-Medicare linked database to better control for case-mix (tumor stage). 3. Prepare the groundwork for studying the fine details of care. To best plan a study of structure, process, and outcomes based on medical records or site visits, we must first understand whether variation in operative mortality rates across hospitals is attributable to specific causes of death. We will develop and test a chart-based instrument for assessing cause of death in a pilot study at two hospitals in northern New England.

Agency
National Institute of Health (NIH)
Institute
National Cancer Institute (NCI)
Type
Research Project (R01)
Project #
5R01CA098481-04
Application #
6944826
Study Section
Social Sciences, Nursing, Epidemiology and Methods 4 (SNEM)
Program Officer
Clauser, Steven
Project Start
2003-09-30
Project End
2008-08-31
Budget Start
2005-09-01
Budget End
2008-08-31
Support Year
4
Fiscal Year
2005
Total Cost
$388,735
Indirect Cost
Name
University of Michigan Ann Arbor
Department
Surgery
Type
Schools of Medicine
DUNS #
073133571
City
Ann Arbor
State
MI
Country
United States
Zip Code
48109
Scally, Christopher P; Yin, Huiying; Birkmeyer, John D et al. (2015) Comparing perioperative processes of care in high and low mortality centers performing pancreatic surgery. J Surg Oncol 112:866-71
Grenda, Tyler R; Revels, Sha'Shonda L; Yin, Huiying et al. (2015) Lung Cancer Resection at Hospitals With High vs Low Mortality Rates. JAMA Surg 150:1034-40
Wong, Sandra L; Revels, Sha?Shonda L; Yin, Huiying et al. (2015) Variation in hospital mortality rates with inpatient cancer surgery. Ann Surg 261:632-6
Revels, Sha'Shonda L; Wong, Sandra L; Banerjee, Mousumi et al. (2014) Differences in perioperative care at low- and high-mortality hospitals with cancer surgery. Ann Surg Oncol 21:2129-35
Gonzalez, Andrew A; Dimick, Justin B; Birkmeyer, John D et al. (2014) Understanding the volume-outcome effect in cardiovascular surgery: the role of failure to rescue. JAMA Surg 149:119-23
Ghaferi, Amir A; Birkmeyer, John D; Dimick, Justin B (2011) Hospital volume and failure to rescue with high-risk surgery. Med Care 49:1076-81
Nicholas, Lauren H; Osborne, Nicholas H; Birkmeyer, John D et al. (2010) Hospital process compliance and surgical outcomes in medicare beneficiaries. Arch Surg 145:999-1004
Ghaferi, Amir A; Osborne, Nicholas H; Birkmeyer, John D et al. (2010) Hospital characteristics associated with failure to rescue from complications after pancreatectomy. J Am Coll Surg 211:325-30
Hollenbeck, Brent K; Dunn, Rodney L; Ye, Zaojun et al. (2010) Racial differences in treatment and outcomes among patients with early stage bladder cancer. Cancer 116:50-6
Ghaferi, Amir A; Birkmeyer, John D; Dimick, Justin B (2009) Complications, failure to rescue, and mortality with major inpatient surgery in medicare patients. Ann Surg 250:1029-34

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