Results from a study presented at the Society for Surgical Oncology Annual Cancer Symposium (March 2-5; Boston, MA) suggest that adhering to National Quality Forum (NQF) colon cancer quality metrics may not correlate with improved survival for patients.
Meredith C Mason, MD, Baylor College of Medicine (Houston, TX), and her colleagues have previously shown that a hospital’s performance on the NQF quality metrics—adequate lymph node evaluation, adjuvant chemotherapy administration for patients with stage 3 disease, and the initiation of adjuvant chemotherapy within 4 months of resection—is poor. However, whether hospital performance on these metrics is associated with improved patient outcomes is still unclear.
Mason and her team conducted a retrospective study of hospitals to determine whether achieving the NQF quality metrics led to better overall survival (OS) in patients with surgically resected stage 3 colon cancer. More than 20,000 patients were identified using the National Cancer Data Base (2003-2005). The researchers then looked at each hospital where patients received treatment and rated them using the proportion of patients for whom each individual metric was achieved. Ratings were then used to categorize each hospital as having very-low (0-25%), low (25-50%), high (50-75%), or very-high (>75%) metric achievement.
Overall, all three metrics were achieved for fewer than half of all patients (47%). Across hospital performance categories, the outcome measures of proportion of patients with postoperative lengths of stay less than 7 days and rates of 30-day readmission were either not significantly associated with performance on the metrics or were not clinically meaningful.
Patients at hospitals that had very high achievement of one or more of the metrics had lower risks of death compared with those at hospitals that did not have very high achievement on any of the metrics. However, this association did not demonstrate a dose–response relationship and was not dependent on which of the metrics or combination of metrics was achieved.
Dr Mason concluded that the lack of a correlation between hospital performance and survival suggests that these metrics may not adequately measure the quality of care for patients with colon cancer. Therefore, efforts should be taken to develop more clinically meaningful quality indicators.
