Dataset Information

Evaluation of Access to Hospitals Most Ready to Achieve National Accreditation for Rectal Cancer Treatment.

ABSTRACT:

Importance

The American College of Surgeons National Accreditation Program for Rectal Cancer (NAPRC) promotes multidisciplinary care to improve oncologic outcomes in rectal cancer. However, accreditation requirements may be difficult to achieve for the lowest-performing institutions. Thus, it is unknown whether the NAPRC will motivate care improvement in these settings or widen disparities.

Objectives

To characterize hospitals' readiness for accreditation and identify differences in the patients cared for in hospitals most and least prepared for accreditation.

Design, setting, and participants

A total of 1315 American College of Surgeons Commission on Cancer-accredited hospitals in the National Cancer Database from January 1, 2011, to December 31, 2015, were sorted into 4 cohorts, organized by high vs low volume and adherence to process standards, and patient and hospital characteristics and oncologic outcomes were compared. The patients included those who underwent surgical resection with curative intent for rectal adenocarcinoma, mucinous adenocarcinoma, or signet ring cell carcinoma. Data analysis was performed from November 2017 to January 2018.

Exposures

Hospitals' readiness for accreditation, as determined by their annual resection volume and adherence to 5 available NAPRC process standards.

Main outcomes and measures

Hospital characteristics, patient sociodemographic characteristics, and 5-year survival by hospital.

Results

Among the 1315 included hospitals, 38 (2.9%) met proposed thresholds for all 5 NAPRC process standards and 220 (16.7%) met the threshold on 4 standards. High-volume hospitals (?20 resections per year) tended to be academic institutions (67 of 104 [64.4%] vs 159 of 1211 [13.1%]; P?=?.001), whereas low-volume hospitals (<20 resections per year) tended to be comprehensive community cancer programs (530 of 1211 [43.8%] vs 28 of 104 [26.9%]; P?=?.001). Patients in low-volume hospitals were more likely to be older (11 429 of 28 076 [40.7%] vs 4339 of 12 148 [35.7%]; P?Conclusions and relevanceHospitals least likely to receive NAPRC accreditation tended to be community institutions with worse survival outcomes, serving patients at a lower socioeconomic position. To possibly avoid exacerbating disparities in access to high-quality rectal cancer care, the NAPRC study findings suggest enabling access for patients with socioeconomic disadvantage or engaging in quality improvement for hospitals not yet achieving accreditation benchmarks.

SUBMITTER: Antunez AG

PROVIDER: S-EPMC6583388 | biostudies-literature | 2019 Jun

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Evaluation of Access to Hospitals Most Ready to Achieve National Accreditation for Rectal Cancer Treatment.

Antunez Alexis G AG Kanters Arielle E AE Regenbogen Scott E SE

JAMA surgery 20190601 6

<h4>Importance</h4>The American College of Surgeons National Accreditation Program for Rectal Cancer (NAPRC) promotes multidisciplinary care to improve oncologic outcomes in rectal cancer. However, accreditation requirements may be difficult to achieve for the lowest-performing institutions. Thus, it is unknown whether the NAPRC will motivate care improvement in these settings or widen disparities.<h4>Objectives</h4>To characterize hospitals' readiness for accreditation and identify differences ...[more]

PMID: 30785616

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Dataset Information

Evaluation of Access to Hospitals Most Ready to Achieve National Accreditation for Rectal Cancer Treatment.

Importance

Objectives

Design, setting, and participants

Exposures

Main outcomes and measures

Results

Publications

Evaluation of Access to Hospitals Most Ready to Achieve National Accreditation for Rectal Cancer Treatment.

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