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In general, hospitals deliver appropriate surgical care to cancer patients with Medicare, study finds

Date:
June 20, 2011
Source:
JAMA and Archives Journals
Summary:
Most hospitals follow established practice guidelines for surgery involving Medicare beneficiaries with cancer, but in some cases their practice patterns diverge from the guidelines, according to a new report.

Most hospitals follow established practice guidelines for surgery involving Medicare beneficiaries with cancer, but in some cases their practice patterns diverge from the guidelines, according to a report published online in Archives of Surgery, one of the JAMA/Archives journals.

According to background information in the article, health care quality has emerged as an important concern in the United States. However, the right care is not always delivered to the right patient at the right time, the authors remark. "Currently, it is well documented that the practice of health care in America varies widely across both institutions and demographic populations," they write. "This is true across specialties and disease sites." These discrepancies may stem from physicians' lack of knowledge about appropriate care, disagreement with generally accepted standards of care or both.

Caprice C. Greenberg, M.D., M.P.H., from Brigham and Women's Hospital, Boston, and colleagues studied National Surveillance, Epidemiology, and End Results data on surgical treatment for five cancers: breast, colon, gastric, rectal, and thyroid. They limited the field to patients ages 65 years and older who were Medicare beneficiaries and were diagnosed with one of those five cancers between January 2000 and December 2005. The researchers analyzed the surgical treatment of these patients for concordance with national cancer-care guidelines classified by the strength of supporting evidence. Specifically, researchers looked at surgical management of the primary tumor, evaluation and treatment of nodes susceptible to cancer, and referral for adjuvant treatment.

The authors identified 11 guidelines for surgical oncology care and determined whether these guidelines were graded by the National Comprehensive Cancer Network (NCCN) as having a high level of evidence or universal consensus but less evidence. For seven of the 11 guidelines, more than 90 percent of hospitals were in concordance, including all guidelines relating to adjuvant therapy. The proportion of hospitals treating 100 percent of their patients in accordance with the guidelines varied; concordance with guidelines was greatest for adjuvant care. patients who were younger, healthier, wealthier, white, had less-aggressive cancers and lived in the Midwest were the most likely to receive appropriate care.

The guidelines most likely to be followed were those which received a high NCCN evidence rating. The authors suggested that the relationship between evidence level and clinical acceptance should be studied further. Additionally, they note, guidelines relating to adjuvant therapy had a high level of concordance. The researchers conclude, "It is critical that surgeons focus on generation of the data necessary to inform clinical decision making and promote high-quality surgical care."


Story Source:

The above story is based on materials provided by JAMA and Archives Journals. Note: Materials may be edited for content and length.


Journal Reference:

  1. Caprice C. Greenberg; Stuart R. Lipsitz; Bridget Neville; Haejin In; Nathanael Hevelone; Stacy A. Porter; Christine Weeks; Ashish K. Jha; Atul A. Gawande; Deborah Schrag; Jane C. Weeks. Receipt of Appropriate Surgical Care for Medicare Beneficiaries With Cancer. Archives of Surgery, 2011; DOI: 10.1001/archsurg.2011.141

Cite This Page:

JAMA and Archives Journals. "In general, hospitals deliver appropriate surgical care to cancer patients with Medicare, study finds." ScienceDaily. ScienceDaily, 20 June 2011. <www.sciencedaily.com/releases/2011/06/110620161206.htm>.
JAMA and Archives Journals. (2011, June 20). In general, hospitals deliver appropriate surgical care to cancer patients with Medicare, study finds. ScienceDaily. Retrieved August 21, 2014 from www.sciencedaily.com/releases/2011/06/110620161206.htm
JAMA and Archives Journals. "In general, hospitals deliver appropriate surgical care to cancer patients with Medicare, study finds." ScienceDaily. www.sciencedaily.com/releases/2011/06/110620161206.htm (accessed August 21, 2014).

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