OBJECTIVE To identify characteristics associated with high- and low-quality multi-hospital systems for major cancer surgery. BACKGROUND Although multi-hospital health systems provide most inpatient healthcare in the US, our understanding of how these systems can optimize surgical quality among their hospitals remains limited. Identifying the structural characteristics (e.g., number of hospitals, procedural volume, geographic dispersion) that distinguish high- and low-quality systems may inform actionable strategies to improve surgical quality. METHODS We conducted a retrospective cross-sectional observational study of 270,491 Medicare beneficiaries (2016-2020) undergoing major cancer surgery at a multi-hospital health system. Systems were classified into quartiles of quality based on risk- and reliability-adjusted rates of 30-day mortality using a hierarchical multivariable logistical regression model to adjust for patient, procedural, and hospital factors. RESULTS The adjusted 30-day operative mortality rate in the highest- versus lowest-quality quartile of systems was 1.7% versus 3.1%,(P<0.001). High-quality systems had fewer hospitals per system (median [IQR], number of system hospitals, 5 [3-11] vs. 12 [8-30];P<0.001), with each performing more procedures per hospital (median [IQR] annual procedure volume, 104 [52-218] vs. 45 [22-90];P<0.001). High-quality systems were also more geographically concentrated (median [IQR] maximum distance between hospitals, 62 [19-194] vs. 321 [91-1125] miles;P<0.001). Furthermore, high-quality systems demonstrated less variation in quality between hospitals (mean [SD] within-system absolute variation in mortality, 0.8% [0.3%] vs. 2.6% [1.0%];P<0.001). CONCLUSIONS The highest-quality multi-hospital systems had fewer, more geographically concentrated hospitals, with each performing more procedures per hospital. Among the highest-quality systems, diverse system phenotypes were represented, suggesting the potential to overcome structural limitations and achieve high quality.

中文翻译：

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进行大型癌症手术的高质量多医院卫生系统的特点。


目的 确定与高质量和低质量的大型癌症手术多医院系统相关的特征。背景技术尽管多医院卫生系统在美国提供大多数住院医疗保健，但我们对这些系统如何优化医院之间的手术质量的理解仍然有限。识别区分高质量和低质量系统的结构特征（例如，医院数量、手术量、地理分布）可以为提高手术质量的可行策略提供信息。方法 我们对 270,491 名在多医院医疗系统接受重大癌症手术的 Medicare 受益人（2016-2020 年）进行了回顾性横断面观察研究。根据 30 天死亡率的风险和可靠性调整率，使用分层多变量逻辑回归模型对患者、手术和医院因素进行调整，将系统分为质量四分位数。结果 最高质量四分位系统与最低质量四分位系统的调整后 30 天手术死亡率分别为 1.7% 和 3.1%（P<0.001）。高质量系统每个系统的医院数量较少（中位数 [IQR]，系统医院数量，5 [3-11] 与 12 [8-30]；P<0.001），每个医院执行的手术较多（中位数 [IQR] 年度手术量，104 [52-218] vs. 45 [22-90]；P<0.001)。高质量系统在地理位置上也更加集中（医院之间的最大距离中位数 [IQR] 为 62 [19-194] 与 321 [91-1125] 英里；P<0.001）。此外，高质量系统表明医院之间的质量差异较小（平均[SD]系统内死亡率绝对差异，0.8% [0.3%] 与 2.6% [1.0%]；P<0.001）。 结论 最高质量的多医院系统的医院数量较少、地理位置更加集中，每个医院执行的手术较多。在最高质量的系统中，代表了不同的系统表型，这表明有克服结构限制并实现高质量的潜力。