Some Quality Metrics Inconsistent With Long-Term Clinical Outcomes Goals
Incentives designed to reduce postoperative readmissions may not have a positive effect on long-term survival.
Instituting a health system–wide quality metric, such as postoperative hospital readmission rate, may be inconsistent with long-term clinical outcomes goals, according to a study presented at the 48th Annual Meeting of the Society of Gynecologic Oncology.1
Many health systems are initiating incentives to reduce postoperative readmissions. The effect of these measures on long-term survival, however, has not been studied. The goal of this study was to determine if neoadjuvant chemotherapy or debulking surgery was associated with hospital readmission and overall survival (OS) among women with epithelial ovarian cancer (EOC).
Data from the National Cancer Data Base were collected between 2006 and 2012 of 26,595 women with stage III EOC treated with chemotherapy and surgery. Neoadjuvant chemotherapy was used in 15.5% of the cohort. Hospital readmission was defined as returning to the facility within 30 days of surgery, and was categorized as planned or unplanned.
Among the cohort, 11.3% of patients were readmitted within 30 days, with 57% of the visits unplanned.
Unplanned readmission was reduced by 37% (relative risk [RR], 0.63; 95% CI, 0.54-0.74) and any readmission was reduced by 48% (RR, 0.52; 95% CI, 0.46-0.59) with neoadjuvant chemotherapy use compared with primary debulking surgery only. Neoadjuvant chemotherapy, however, was associated with an increased risk of all-cause mortality (hazard ratio, 1.36; 95% CI, 1.29-1.42).The data from this study indicate that although neoadjuvant chemotherapy reduced 30-day hospital readmission rates, it was associated with a decrease in survival. The authors suggest that “hospital-wide quality metrics, such as postoperative readmission, may be creating incentives inconsistent with long-term goals, such as improved survival.”
1. Barber EL, Rossi EC, Gehrig PA. Surgical readmission and survival in women with ovarian cancer: are short term quality metrics incentivizing decreased long term survival? Presented at: 48th Annual Meeting of the Society of Gynecologic Oncology; March 12-15, 2017; National Harbor, MD.