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Association of Delivery System Integration and Outcomes for Major Cancer Surgery

  • Health Services Research and Global Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Integrated delivery systems (IDSs) are postulated to reduce spending and improve outcomes through successful coordination of care across multiple providers. Nonetheless, the actual impact of IDSs on outcomes for complex multidisciplinary care such as major cancer surgery is largely unknown.

Methods

Using 2011–2013 Medicare data, this study identified patients who underwent surgical resection for prostate, bladder, esophageal, pancreatic, lung, liver, kidney, colorectal, or ovarian cancer. Rates of readmission, 30-day mortality, surgical complications, failure to rescue, and prolonged hospital stay for cancer surgery were compared between patients receiving care at IDS hospitals and those receiving care at non-IDS hospitals. Generalized estimating equations were used to adjust results by cancer type and patient- and hospital-level characteristics while accounting for clustering of patients within hospitals.

Results

The study identified 380,053 patients who underwent major resection of cancer, with 38% receiving care at an IDS. Outcomes did not differ between IDS and non-IDS hospitals regarding readmission and surgical complication rates, whereas only minor differences were observed for 30-day mortality (3.5% vs 3.2% for IDS; p < 0.001) and prolonged hospital stay (9.9% vs 9.2% for IDS; p < 0.001). However, after adjustment for patient and hospital characteristics, the frequencies of adverse perioperative outcomes were not significantly associated with IDS status.

Conclusions

The collective findings suggest that local delivery system integration alone does not necessarily have an impact on perioperative outcomes in surgical oncology. Moving forward, stakeholders may need to focus on surgical and oncology-specific methods of care coordination and quality improvement initiatives to improve outcomes for patients undergoing cancer surgery.

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Acknowledgments

This research was supported by funding from the National Cancer Institute (1-R01-CA-174768-01-A1 to Dr. David Miller) and from the National Institute on Aging (R01-AG048071 to Dr. Brent Hollenbeck).

Disclosure

James Dupree receives support from Blue Cross Blue Shield: Michigan Value Collaborative and Michigan Urological Surgery Improvement Collaborative. Deborah Kaye receives support from NCI 5-T32-CA-180984-03. David Miller receives support from NCI 1-R01-CA-174768-01A1, Blue Cross Blue Shield: Michigan Value Collaborative and Michigan Urological Surgery Improvement Collaborative. Brent Hollenbeck receives support from R01-AG048071. Jonathan Li receives support from TL1TR000435 and TL1TR002242. Zaojun Ye, Hye Sung Min, Chad Ellimoottil, and Lindsey Herrel declare that they have no relevant financial interests.

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Authors and Affiliations

  1. Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA

    Jonathan Li BSE, Zaojun Ye MS, James M. Dupree MD, MPH, Brent K. Hollenbeck MD, MS, Hye Sung Min MS, Deborah Kaye MD, Lindsey A. Herrel MD, MS, David C. Miller MD, MPH & Chad Ellimoottil MD, MS

  2. Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI, USA

    Jonathan Li BSE, Zaojun Ye MS, James M. Dupree MD, MPH, Brent K. Hollenbeck MD, MS, Hye Sung Min MS, Deborah Kaye MD, Lindsey A. Herrel MD, MS, David C. Miller MD, MPH & Chad Ellimoottil MD, MS

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Correspondence to Chad Ellimoottil MD, MS.

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Li, J., Ye, Z., Dupree, J.M. et al. Association of Delivery System Integration and Outcomes for Major Cancer Surgery. Ann Surg Oncol 25, 856–863 (2018). https://doi.org/10.1245/s10434-017-6312-6

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