The majority of hospitals in the USA that carry out surgery for Medicare beneficiaries follow established guidelines, although some may diverge, researchers from Brigham and Women’s Hospital, Boston, reported in Archives of Surgery today. The issue of health care quality has become much more of a priority in the USA over the last few years, the authors added.
The researchers pointed out, though, that appropriate care at the right time is not always delivered to the right patient
They wrote:
“Currently, it is well documented that the practice of health care in America varies widely across both institutions and demographic populations. This is true across specialties and disease sites.”
These inconsistencies may be a result of:
- Lack of knowledge by doctors regarding appropriate care
- The doctor disagrees with generally accepted standards
- A combination of both
Caprice C. Greenberg, M.D., M.P.H., set out to determine what proportion of cancer operations for Medicare patients stuck to generally accepted guidelines. They gathered data from the National Surveillance, Epidemiology, and End Results, and focused on surgical treatments for breast, colon, thyroid, rectal and gastric cancers. All patients were aged 65+ years and had received a cancer diagnosis between January 2000 and December 2005.
They assessed the surgical treatments given, focusing on compliance with national cancer-care guidelines classified by the strength of supporting evidence. They concentrated mainly on surgery aimed at the primary tumor, evaluation and treatment of susceptible-to-cancer nodes, and referral for adjuvant treatment.
They identified 11 guidelines for cancer surgery and care and decided whether the guidelines were graded by the NCCN (National Comprehensive Cancer Network) as having a high level of evidence or universal consensus (but with less evidence).
90% of hospitals were in concordance with 7 of the 11 guidelines, including adjuvant therapy guidelines.
The percentage of hospitals that treated 100% of their Medicare beneficiaries in accordance with guidelines varied. The highest proportion was for adjuvant care.
The following kinds of patients were found to be more likely to receive appropriate care:
- Caucasian patients
- Healthier patients
- Those who lived in the Midwest
- Those with less-aggressive cancers
- Well off patients
- Younger patients
Guidelines with the highest NCCN evidence ratings had the greatest likelihood of being followed, the authors noted.
Further studies should look into the relationship between clinical acceptance and evidence levels, they added.
The authors concluded:
“It is critical that surgeons focus on generation of the data necessary to inform clinical decision making and promote high-quality surgical care.”
Written by Christian Nordqvist