The impact of treatment facility type on the survival of brain metastases patients regardless of the primary cancer type

Amin, Saber; Baine, Michael J.; Meza, Jane L.; Lin, Chi

doi:10.1186/s12885-021-08129-4

Cited by 14 publications

(11 citation statements)

References 36 publications

(17 reference statements)

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“…An invitation to participate was issued from April 8, 2021, through June 1, 2021, to all 1456 CoC‐accredited facilities and 582 NAPBC‐accredited facilities, which treat nearly 70% of recently diagnosed US patients with cancer annually. Accredited facilities are categorized according to the type of facility, program structure, services provided, and yearly patient case volume 6,7 . Per the CoC definition, an academic facility is defined as an institution that must have more than 500 newly diagnosed cancer cases per year and is either associated with a National Cancer Institute–designated comprehensive cancer center or provides postgraduate medical education.…”

Section: Methodsmentioning

confidence: 99%

“…Accredited facilities are categorized according to the type of facility, program structure, services provided, and yearly patient case volume. 6,7 Per the CoC definition, an academic facility is defined as an institution that must have more than 500 newly diagnosed cancer cases per year and is either associated with a National Cancer Institutedesignated comprehensive cancer center or provides postgraduate medical education. Comprehensive community cancer programs have more than 500 newly diagnosed cancer cases per year, and community cancer programs have 100 to 500 newly diagnosed cancer cases per year.…”

Section: Methodsmentioning

confidence: 99%

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A national quality improvement study identifying and addressing cancer screening deficits due to the COVID‐19 pandemic

Joung

Nelson

Mullett

et al. 2022

Cancer

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BACKGROUND: Cancer-related deaths over the next decade are expected to increase due to cancer screening deficits associated with the coronavirus disease 2019 (COVID-19) pandemic. Although national deficits have been quantified, a structured response to identifying and addressing local deficits has not been widely available. The objectives of this report are to share preliminary data on monthly screening deficits in breast, colorectal, lung, and cervical cancers across diverse settings and to provide online materials from a national quality improvement (QI) study to help other institutions to address local screening deficits. METHODS: This prospective, national QI study on Return-to-Screening enrolled 748 accredited cancer programs in the United States from April through June 2021. Local prepandemic and pandemic monthly screening test volumes (MTVs) were used to calculate the relative percent change in MTV to describe the monthly screening gap. RESULTS: The majority of facilities reported monthly screening deficits (colorectal cancer, 80.6% [n = 104/129]; cervical cancer, 69.0% [n = 20/29]; breast cancer, 55.3% [n = 241/436]; lung cancer, 44.6% [n = 98/220]). Overall, the median relative percent change in MTV ranged from -17.7% for colorectal cancer (interquartile range [IQR], -33.6% to -2.8%), -6.8% for cervical cancer (IQR, -29.4% to 1.7%), -1.6% for breast cancer (IQR, -9.6% to 7.0%), and 1.2% for lung cancer (IQR, -16.9% to 19.0%). Geographic differences were not observed. There were statistically significant differences in the percent change in MTV between institution types for colorectal cancer screening (P = .02). CONCLUSION: Cancer screening is still in need of urgent attention, and the screening resources made available online may help facilities to close critical gaps and address screenings missed in 2020.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

A national quality improvement study identifying and addressing cancer screening deficits due to the COVID‐19 pandemic

Joung

Nelson

Mullett

et al. 2022

Cancer

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“…11 CoC-accredited programs are further categorized according to the type of facility, program structure, services provided, and yearly patient case volume. 4 , 12 , 13 …”

Section: Methodsmentioning

confidence: 99%

“…These accredited programs include hospitals, treatment centers, and other cancer facilities that demonstrate ongoing compliance with a rigorous set of standards designed to support the full continuum of quality cancer care . CoC-accredited programs are further categorized according to the type of facility, program structure, services provided, and yearly patient case volume …”

Section: Methodsmentioning

confidence: 99%

“…11 CoC-accredited programs are further categorized according to the type of facility, program structure, services provided, and yearly patient case volume. 4,12,13 Participation in the Return-to-Screening Collaborative and successful completion of each QI project led to program accruals of existing relevant standards in cancer screening event, QI initiative, and clinical research. CoC programs were enrolled in 1 or more independent QI projects in breast, colon, lung, and cervical cancer screening, whereas NAPBC programs were enrolled in breast cancer screening projects, and multidisciplinary local QI teams involving key stakeholders were assembled.…”

Section: Study Population and Enrollment In The Return-to-screening C...mentioning

confidence: 99%

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Evaluation of a National Quality Improvement Collaborative for Improving Cancer Screening

et al. 2022

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ImportanceCancer screening deficits during the first year of the COVID-19 pandemic were found to persist into 2021. Cancer-related deaths over the next decade are projected to increase if these deficits are not addressed.ObjectiveTo assess whether participation in a nationwide quality improvement (QI) collaborative, Return-to-Screening, was associated with restoration of cancer screening.Design, Setting, and ParticipantsAccredited cancer programs electively enrolled in this QI study. Project-specific targets were established on the basis of differences in mean monthly screening test volumes (MTVs) between representative prepandemic (September 2019 and January 2020) and pandemic (September 2020 and January 2021) periods to restore prepandemic volumes and achieve a minimum of 10% increase in MTV. Local QI teams implemented evidence-based screening interventions from June to November 2021 (intervention period), iteratively adjusting interventions according to their MTVs and target. Interrupted time series analyses was used to identify the intervention effect. Data analysis was performed from January to April 2022.ExposuresCollaborative QI support included provision of a Return-to-Screening plan-do-study-act protocol, evidence-based screening interventions, QI education, programmatic coordination, and calculation of screening deficits and targets.Main Outcomes and MeasuresThe primary outcome was the proportion of QI projects reaching target MTV and counterfactual differences in the aggregate number of screening tests across time periods.ResultsOf 859 cancer screening QI projects (452 for breast cancer, 134 for colorectal cancer, 244 for lung cancer, and 29 for cervical cancer) conducted by 786 accredited cancer programs, 676 projects (79%) reached their target MTV. There were no hospital characteristics associated with increased likelihood of reaching target MTV except for disease site (lung vs breast, odds ratio, 2.8; 95% CI, 1.7 to 4.7). During the preintervention period (April to May 2021), there was a decrease in the mean MTV (slope, −13.1 tests per month; 95% CI, −23.1 to −3.2 tests per month). Interventions were associated with a significant immediate (slope, 101.0 tests per month; 95% CI, 49.1 to 153.0 tests per month) and sustained (slope, 36.3 tests per month; 95% CI, 5.3 to 67.3 tests per month) increase in MTVs relative to the preintervention trends. Additional screening tests were performed during the intervention period compared with the prepandemic period (170 748 tests), the pandemic period (210 450 tests), and the preintervention period (722 427 tests).Conclusions and RelevanceIn this QI study, participation in a national Return-to-Screening collaborative with a multifaceted QI intervention was associated with improvements in cancer screening. Future collaborative QI endeavors leveraging accreditation infrastructure may help address other gaps in cancer care.

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Role of Hospital Connectedness in Brain Metastasis Outcomes

Tong,

Patel,

Aizer

et al. 2024

JAMA Netw Open

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ImportanceAlthough patients with brain metastases receive interdisciplinary and multi-institutional care, the association between neuro-oncologic care networks and patient outcomes remains unknown. As patients often interact with multiple facilities, quantifying this association across a network of hospitals is critical to capture the complexity of the health care journey for patients with brain metastases.ObjectiveTo evaluate how statewide health care network metrics are associated with inpatient mortality and hospital length of stay (LOS) for patients with brain metastases.Design, Setting, and ParticipantsThis multicenter, statewide cohort study used data from the 2018 to 2019 Healthcare Cost and Utilization Project State Inpatient and Emergency Department Databases. Primary analyses were completed by August 2023. Participants included adults with a brain metastases receiving care in Massachusetts.ExposureAll inpatient and emergency department visits mapped for patients following the first diagnosis of brain metastasis.Main Outcomes and MeasuresInpatient mortality and hospital LOS were the main outcomes assessed. Hospital interdependence in brain metastases care was calculated using a connectedness score (weighted degree: weighted sum of ties to other care facilities). The association between hospital connectedness and clinical outcomes was analyzed using mixed-effects logistic and linear regression models, adjusting for hospital-level features.ResultsIn this cohort study, 4679 patients with brain metastases were identified with inpatient or ED encounters in Massachusetts (from 2018 to 2019). The median (IQR) age was 64 (57-73) years, and 2559 (55%) were female. There was interdependence in brain metastases care, with 993 patients (21%) visiting 2 or more unique hospitals. Highly connected hospitals were heterogeneous, with many being small and one-half lacking subspecialty neuro-oncologic care or teaching status. Increased hospital connectedness was significantly associated with improved inpatient mortality for patients with brain metastases, with the lowest connectedness quartile associated with more than double the risk of mortality compared with the highest quartile (odds ratio, 2.34; 95% CI, 1.33-4.11; P = .003). A stepwise increase in inpatient mortality risk was observed as hospital connectedness decreased, independently of hospital volume. Furthermore, intermediate hospital connectedness was associated with increased hospital LOS (coefficient, 1.08; 95% CI, 0.17-1.95; P = .006).Conclusions and RelevanceThis study found that hospital-to-hospital interconnectedness was significantly associated with improved clinical outcomes for patients with brain metastases. The salience of network metrics highlights their potential role alongside other patient-level and hospital-level variables to evaluate and improve oncology care delivery.

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The impact of treatment facility type on the survival of brain metastases patients regardless of the primary cancer type

Cited by 14 publications

References 36 publications

A national quality improvement study identifying and addressing cancer screening deficits due to the COVID‐19 pandemic

A national quality improvement study identifying and addressing cancer screening deficits due to the COVID‐19 pandemic

Evaluation of a National Quality Improvement Collaborative for Improving Cancer Screening

Role of Hospital Connectedness in Brain Metastasis Outcomes

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