Identifying Opportunities to Deliver High-Quality Cancer Care Across a Health System: A Clinical Responsibility. 

 -  2024 
<br/><br/>Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006 
<br/><br/> CONCLUSION: Quality of oral cancer care across the health system and region is comparable to or better-than national standards, indicating good baseline quality of care. Differences by facility type and fragmentation of care present an opportunity for bringing best in-class cancer care across an entire region. Copyright © 2024 American Academy of Otolaryngology-Head and Neck Surgery Foundation.  METHODS: Patients with OSCC diagnosed between 2012 and 2018 were identified from tumor registries of 6 hospitals (1 academic and 5 community) within a single health system. Patients were categorized into 3 care groups: (1) solely at the academic center, (2) solely at community facilities, and (3) combined care at academic and community facilities. Primary outcome measures were process-related quality metrics: positive surgical margin rate, lymph node yield (LNY), adjuvant treatment initiation <=6 weeks, National Comprehensive Cancer Network (NCCN)-guideline adherence.  OBJECTIVE: We examined process-related quality metrics for oral squamous cell carcinoma (OSCC) depending on treating facility type across a health system and region.  RESULTS: A total of 499 patients were included: 307 (61.5%) patients in the academic-only group, 101 (20.2%) in the community-only group, and 91 (18.2%) in the combined group. Surgery at community hospitals was associated with increased odds of positive surgical margins (11.9% vs 2.5%, odds ratio [OR]: 47.73, 95% confidence interval [CI]: 11.2-275.86, P < .001) and lower odds of LNY >= 18 (52.8% vs 85.9%, OR: 0.15, 95% CI: 0.07-0.33, P < .001) relative to the academic center. Compared with the academic-only group, odds of adjuvant treatment initiation <=6 weeks were lower for the combined group (OR: 0.30, 95% CI: 0.13-0.64, P = .002) and odds of NCCN guideline-adherent treatment were lower in the community only group (OR: 0.35, 95% CI: 0.18-0.70, P = .003).  SETTING: Single health system and region.  STUDY DESIGN: Retrospective in accordance with Strengthening the Reporting of Observational Studies in Epidemiology guidelines. 
<br/><br/><br/>English 
<br/><br/><label>ISSN: </label>0194-5998 
<br/><br/><label>Subjects--Topical Terms: </label>--Automated<br/>IN PROCESS -- NOT YET INDEXED
<br/><br/><label>Index Terms--Occupation: </label><br/>MedStar Georgetown University Hospital/MedStar Washington Hospital Center<br/>Otolaryngology Residency
<br/><br/><label>Index Terms--Function: </label><br/>Journal Article