Markey Cancer Center, Cancer Prevention and Control Program, University of Kentucky, Lexington, KY, USA.
Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY, USA.
Ann Surg Oncol. 2021 Feb;28(2):632-638. doi: 10.1245/s10434-020-08867-y. Epub 2020 Jul 25.
Cancer patients treated in community hospitals receive less guideline-recommended care and experience poorer outcomes than those treated in academic medical centers or National Cancer Institute-Designated Cancer Centers. The Markey Cancer Center Affiliate Network (MCCAN) was designed to address this issue in Kentucky, the state with the highest cancer incidence and mortality rates in the U.S.
Using data obtained from the Kentucky Cancer Registry, the study evaluated the impact of patients treated in MCCAN hospitals on four evidence-based Commission on Cancer (CoC) quality measures using a before-and-after matched-cohort study design. Each group included 13 hospitals matched for bed size, cancer patient volume, community population, and region (Appalachian vs. non-Appalachian). Compliance with quality measures was assessed for the 3 years before the hospital joined MCCAN (T1) and the 3 years afterward (T2).
In T1, the control hospitals demonstrated greater compliance with two quality measures than the MCCAN hospitals. In T2, the MCCAN hospitals achieved greater compliance in three measures than the control hospitals. From T1 to T2, the MCCAN hospitals significantly increased compliance on three measures (vs. 1 measure for the control hospitals). Although most of the hospitals were not accredited by the CoC in T1, 92% of the MCCAN hospitals had achieved accreditation by the end of T2 compared with 23% of the control hospitals.
After the MCCAN hospitals joined the Network, their compliance with quality measures and achievement of CoC accreditation increased significantly compared with the control hospitals. The unique academic/community-collaboration model provided by MCCAN was able to make a significant impact on improvement of cancer care. Future research is needed to adapt and evaluate similar interventions in other states and regions.
在社区医院接受治疗的癌症患者接受的治疗方案与推荐方案的符合程度以及治疗效果不如在学术医疗中心或美国国家癌症研究所指定癌症中心接受治疗的患者。Markey 癌症中心附属网络（MCCAN）的建立是为了解决肯塔基州的这一问题，该州是美国癌症发病率和死亡率最高的州。
本研究使用肯塔基州癌症登记处的数据，采用前后匹配队列研究设计，评估了 MCCAN 医院治疗的患者对四项基于循证医学的癌症委员会（CoC）质量指标的影响。每组包括 13 家医院，这些医院在床位数、癌症患者数量、社区人口和地区（阿巴拉契亚地区与非阿巴拉契亚地区）方面进行了匹配。在医院加入 MCCAN 之前的 3 年（T1）和之后的 3 年（T2）评估了对质量指标的遵守情况。
在 T1 中，对照组医院在两项质量指标上的符合率高于 MCCAN 医院。在 T2 中，MCCAN 医院在三项措施上的符合率高于对照组医院。从 T1 到 T2，MCCAN 医院在三项措施上的符合率显著提高（而对照组医院仅提高了一项）。尽管在 T1 时大多数医院未获得 CoC 的认证，但到 T2 结束时，92%的 MCCAN 医院获得了认证，而对照组医院仅有 23%。
在 MCCAN 医院加入该网络后，与对照组医院相比，其对质量指标的遵守程度和 CoC 认证的获得率显著提高。MCCAN 提供的独特的学术/社区合作模式能够对改善癌症治疗产生重大影响。未来需要开展研究，以评估和改进在其他州和地区的类似干预措施。
