Papageorge Marianna V, Resio Benjamin J, Monsalve Andres F, Canavan Maureen, Pathak Ranjan, Mase Vincent J, Dhanasopon Andrew P, Hoag Jessica R, Blasberg Justin D, Boffa Daniel J
Section of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA.
Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale School of Medicine, New Haven, CT, USA.
JNCI Cancer Spectr. 2020 Jul 7;4(5):pkaa059. doi: 10.1093/jncics/pkaa059. eCollection 2020 Oct.
The Centers for Medicare and Medicaid Services (CMS) developed risk-adjusted "Star Ratings," which serve as a guide for patients to compare hospital quality (1 star = lowest, 5 stars = highest). Although star ratings are not based on surgical care, for many procedures, surgical outcomes are concordant with star ratings. In an effort to address variability in hospital mortality after complex cancer surgery, the use of CMS Star Ratings to identify the safest hospitals was evaluated.
Patients older than 65 years of age who underwent complex cancer surgery (lobectomy, colectomy, gastrectomy, esophagectomy, pancreaticoduodenectomy) were evaluated in CMS Medicare Provider Analysis and Review files (2013-2016). The impact of reassignment was modeled by applying adjusted mortality rates of patients treated at 5-star hospitals to those at 1-star hospitals (Peters-Belson method).
There were 105 823 patients who underwent surgery at 3146 hospitals. The 90-day mortality decreased with increasing star rating (1 star = 10.4%, 95% confidence interval [CI] = 9.8% to 11.1%; and 5 stars = 6.4%, 95% CI = 6.0% to 6.8%). Reassignment of patients from 1-star to 5-star hospitals (7.8% of patients) was predicted to save 84 Medicare beneficiaries each year. This impact varied by procedure (colectomy = 47 lives per year; gastrectomy = 5 lives per year). Overall, 2189 patients would have to change hospitals each year to improve outcomes (26 patients moved to save 1 life).
Mortality after complex cancer surgery is associated with CMS Star Rating. However, the use of CMS Star Ratings by patients to identify the safest hospitals for cancer surgery would be relatively inefficient and of only modest impact.
医疗保险和医疗补助服务中心（CMS）制定了风险调整后的“星级评定”，作为患者比较医院质量的指南（1星 = 最低，5星 = 最高）。尽管星级评定并非基于外科护理，但对于许多手术来说，手术结果与星级评定是一致的。为了应对复杂癌症手术后医院死亡率的差异，对使用CMS星级评定来确定最安全的医院进行了评估。
在CMS医疗保险提供者分析与审查文件（2013 - 2016年）中评估了年龄超过65岁且接受复杂癌症手术（肺叶切除术、结肠切除术、胃切除术、食管切除术、胰十二指肠切除术）的患者。通过将5星级医院治疗患者的调整后死亡率应用于1星级医院的患者（彼得斯 - 贝尔森方法）来模拟重新分配的影响。
有105823名患者在3146家医院接受手术。90天死亡率随着星级升高而降低（1星 = 10.4%，95%置信区间[CI] = 9.8%至11.1%；5星 = 6.4%，95%CI = 6.0%至6.8%）。预计将患者从1星级医院重新分配到5星级医院（占患者的7.8%）每年可挽救84名医疗保险受益人的生命。这种影响因手术而异（结肠切除术 = 每年挽救47条生命；胃切除术 = 每年挽救5条生命）。总体而言，每年需要2189名患者更换医院才能改善结果（26名患者更换医院可挽救1条生命）。
复杂癌症手术后的死亡率与CMS星级评定相关。然而，患者使用CMS星级评定来确定癌症手术最安全的医院效率相对较低，且影响有限。
